Method for the Detection and Handling of Hypoglycemia

ABSTRACT

A method is described herein to detect and treat hypoglycemia. An example of this method involves the detection of hypoglycemia in a patient with a computing device, computation of a recommended carbohydrate amount to ingest by the patient with the computing device in response to said detecting the hypoglycemia, output of the recommended carbohydrate amount with the computing device, and the performance of a hypoglycemia surveillance with the computing device to determine whether the recommended carbohydrate amount remedied the hypoglycemia.

BACKGROUND

Diabetics are always attempting to tightly control their blood glucoselevels so as to avoid the detrimental effects of their condition. Highblood glucose levels, commonly referred to as hyperglycemia, can forexample lead to organ damage, ketoacidosis, and/or long termdebilitating or life-threatening conditions. If left untreated, lowblood glucose conditions, commonly referred to as hypoglycemia, can leadto unconsciousness or even death. To avoid these problems, diabeticstypically monitor their blood glucose levels closely and sometimes makeadjustments to their treatment regimen so as to avoid hypoglycemia andhyperglycemia. For example, when experiencing hypoglycemia, a healthcare provider (HCP) may recommend that a diabetic ingest a specificamount of carbohydrates (e.g., drink a specific amount of orange juice)in order to raise their blood glucose levels. However, follow upassessments to see if the hypoglycemia has been addressed sometimes doesnot occur. Moreover, the prescribed amount of carbohydrate may not beappropriate in some circumstances.

Hypoglycemia occurs when glucose is lacking in the blood plasma. Thus,hypoglycemia is usually detected by the use of spot monitoring bymeasuring blood glucose concentration intracellular glucose deficiency(IGD) is caused by decreased performance of tissues whose cell plasmacontains too little glucose. When an individual has excessive amounts ofinsulin, glucose migrates in the cells, thereby inducing a decrease inglucose concentration in both the blood plasma and the interstitialfluid (ISF). This in turn can lead to both hypoglycemia andintracellular glucose deficiency. Blood plasma glucose concentration(BG) and tissue glucose concentration (TG) vary as a function ofendogenous glucose production and glucose consumption in the cells.However, such a change does not occur at the same time in blood andtissue. Consequently, there is a delay between changes in blood plasmaglucose concentration and tissue glucose concentration. This delayvaries depending on the tissue type but the average time difference canspan up to 20 minutes and the difference in concentration can beestimated to about 30 mg/dL in up to 66% of the body locations. Itshould be recognized that this delay can create a whole host of issuesin properly remedying a hypoglycemic event.

Thus, there is a need for improvement in this field.

SUMMARY

According to at least one exemplary embodiment of the presentdisclosure, a method of detecting and treating hypoglycemia is provided.

According to at least one embodiment of the method of the presentdisclosure, the method, comprises detecting hypoglycemia in a patientwith a computing device based at least on the patient having a symptomof hypoglycemia, receiving with the computing device a blood glucosemeasurement of the patient, computing a recommended carbohydrate amountto ingest by the patient with the computing device in response to saiddetecting the hypoglycemia, wherein the recommended carbohydrate amountis based at least in part on the blood glucose measurement of thepatient, and outputting the recommended carbohydrate amount with thecomputing device.

According to at least one embodiment of the method of the presentdisclosure, the method comprises receiving with a computing device ablood glucose measurement of a patient, computing a recommendedcarbohydrate amount to ingest by the patient with the computing device,wherein the recommended carbohydrate amount is based at least on theblood glucose measurement of the patient, wherein said computing therecommended carbohydrate amount includes adjusting the recommendedcarbohydrate amount based on an amount of carbohydrates consumed by thepatient during a timeframe, and outputting the recommended carbohydrateamount with the computing device.

According to at least one embodiment of the method of the presentdisclosure, the method, comprises detecting hypoglycemia in a patientwith a computing device, computing a recommended carbohydrate amount toingest by the patient with the computing device in response to saiddetecting the hypoglycemia, outputting the recommended carbohydrateamount with the computing device, and performing hypoglycemiasurveillance with the computing device to determine whether therecommended carbohydrate amount remedied the hypoglycemia.

In at least one embodiment of the present disclosure, computating therecommended carbohydrate amount includes adjusting the recommendedcarbohydrate amount based on amount of carbohydrates consumed by thepatient during a timeframe.

In at least one embodiment of the present disclosure, the method furthercomprises performing hypoglycemia surveillance with the computing deviceto determine whether the recommended carbohydrate amount remedied thehypoglycemia.

In at least one embodiment of the present disclosure, the hypoglycemiasurveillance includes receiving with the computing device a second bloodglucose measurement of the patient after said computing the recommendedcarbohydrate amount and determining with the computing device that thehypoglycemia has been remedied based at least on the second bloodglucose measurement.

In at least one embodiment of the present disclosure, the method furthercomprises receiving with the computing device data indicating that thepatient lacks hypoglycemia symptoms after said computing the recommendedcarbohydrate amount and determining with the computing device that thehypoglycemia has been remedied based at least on the lack of thehypoglycemia symptoms.

In at least one embodiment of the present disclosure, the method furthercomprises delaying said performing the hypoglycemia surveillance for adelay period.

In at least one embodiment of the present disclosure, the delay periodis at least 15 minutes.

In at least one embodiment of the present disclosure, the method furthercomprises ending said performing the hypoglycemia surveillance when thesecond blood glucose measurement exceeds a surveillance end threshold.

In at least one embodiment of the present disclosure, the surveillanceend threshold is 100 mg/dl.

In at least one embodiment of the present disclosure, the method furthercomprises ending said performing the hypoglycemia surveillance when thesecond blood glucose measurement exceeds a relative threshold thatvaries based on amount of carbohydrates previously consumed.

In at least one embodiment of the present disclosure, the relativethreshold is based on a time dependent carbohydrate absorption functionthat increases with time.

In at least one embodiment of the present disclosure, the method furthercomprises calculating with the computing device the relative thresholdusing the following formula

BG_(end,relative)=γ(−t ₁)·BG_(hypo,end)+(1−γ(t−t ₁))·BG₀

where:

-   -   BG_(end,relative)=Relative threshold for ending the surveillance        phase;    -   BG_(hypo,end)=Threshold where hypoglycemia is considered ended;    -   γ(x)=Carbohydrate absorption function for time interval x;    -   t=Current time when relative threshold is being calculated;    -   t₁=Time when first carbohydrate recommended or consumed; and    -   BG₀=Original blood glucose measurement.

In at least one embodiment of the present disclosure, the method furthercomprises receiving a third blood glucose measurement, and calculatingwith the computing device the relative threshold using the followingformula

${BG}_{{end},{relative}} = {{{\gamma \left( {t - t_{2}} \right)} \cdot {BG}_{{hypo},{end}}} + {\left( {1 - {\gamma \left( {t - t_{2}} \right)}} \right) \cdot {BG}_{2}} + {\frac{\gamma \left( {t - t_{2}} \right)}{\gamma \left( {t_{2} - t_{1}} \right)}\left( {{\gamma \left( {t - t_{1}} \right)} - 1} \right)\left( {{BG}_{2} - {BG}_{1}} \right)}}$

where:

-   -   BG_(end,relative)=Relative threshold for ending the surveillance        phase;    -   BG_(hypo,end)=Threshold where hypoglycemia is considered ended;    -   γ(x)=Carbohydrate absorption function for time interval x;    -   t=Current time when relative threshold is being calculated;    -   t_(n)=Time of n^(th) measurement since hypoglycemia; and    -   BG_(n)=n^(th) blood glucose measurement since hypoglycemia.

In at least one embodiment of the present disclosure, the recommendedcarbohydrate amount is selected from a group consisting of a smallcarbohydrate amount, a medium carbohydrate amount, and a largecarbohydrate amount.

In at least one embodiment of the present disclosure, the method furthercomprises normalizing the recommended carbohydrate amount based onpatient weight.

In at least one embodiment of the present disclosure, the method furthercomprises adjusting the recommended carbohydrate amount based on patientweight risk of fainting during hypoglycemia.

In at least one embodiment of the present disclosure, the method furthercomprises adjusting the recommended carbohydrate amount based on a totaldaily dose of insulin by the patient.

In at least one embodiment of the present disclosure, the method furthercomprises calculating with the computing device the recommendedcarbohydrate amount using the following formula

$\quad\left\{ \begin{matrix}{n_{{BU},{small}} = {f_{n}\left( {n_{{BU},{TDD}} + n_{{BU},{fainting}}} \right)}} \\{n_{{BU},{medium}} = {f_{n}\left( {n_{{BU},{TDD}} + n_{{BU},{fainting}} + 1} \right)}} \\{n_{{BU},{large}} = {f_{n}\left( {n_{{BU},{TDD}} + n_{{BU},{fainting}} + 2} \right)}}\end{matrix} \right.$

-   -   where:        -   n_(BU,small)=Small amount of carbohydrate;        -   n_(BU,medium)=Medium amount of carbohydrate;        -   n_(BU,large)=Large amount of carbohydrate;        -   f_(n)=Normalization factor based on patient weight;        -   n_(BU,fainting)=Risk of fainting additional bread unit; and        -   n_(BU,TDD)=Additional bread unit recommended for patients            with a total daily dose (TDD) of insulin ≤30 UI.

In at least one embodiment of the present disclosure, computing therecommended carbohydrate amount includes selecting the smallcarbohydrate amount, the medium carbohydrate amount, and the largecarbohydrate amount based on a very low blood glucose limit, a low bloodglucose limit, and a medium-low blood glucose limit.

In at least one embodiment of the present disclosure, the very low bloodglucose limit, the low blood glucose limit, and the medium-low bloodglucose limit are respectively 60 mg/dl, 100 mg/dl, and 140 mg/dl.

In at least one embodiment of the present disclosure, the method furthercomprises calculating with the computing device the recommendedcarbohydrate amount using the following formula

$\begin{matrix}{n_{BU} = \left\{ \begin{matrix}0 & {{{if}\mspace{14mu} {BG}_{ml}} < {BG}} \\n_{{BU},{small}} & {{{if}\mspace{14mu} {BG}_{l}} < {BG} \leq {BG}_{ml}} \\n_{{BU},{medium}} & {{{if}\mspace{14mu} {BG}_{vl}} < {BG} \leq {BG}_{l}} \\n_{{BU},{large}} & {{{if}\mspace{14mu} {BG}} \leq {BG}_{vl}}\end{matrix} \right.} & {{Equation}\mspace{14mu} 21}\end{matrix}$

-   -   where:        -   n_(BU)=Amount of carbohydrate;        -   n_(BU,small)=Small amount of carbohydrate;        -   n_(BU,medium)=Medium amount of carbohydrate;        -   n_(BU,large)=Large amount of carbohydrate;        -   BG₁=Blood glucose measurement at hypoglycemia detection;        -   BG_(ml)=Medium-low blood glucose range limit;        -   BG_(l)=Low blood glucose range limit; and        -   BG_(vl)=Very low blood glucose range limit.

In at least one embodiment of the present disclosure, computing therecommended carbohydrate amount includes adjusting the recommendedcarbohydrate amount based on prior blood glucose measurements made afterdetecting the hypoglycemia, prior amounts of carbohydrates ingested, anda carbohydrate absorption function.

In at least one embodiment of the present disclosure, the method furthercomprises receiving a second blood glucose measurement after the patientingested the second recommended amount of carbohydrate and calculatingwith the computing device a second recommended carbohydrate amount usingthe following formula

$\left\{ \begin{matrix}{{BG}_{{vl},2} = {{{\gamma \left( {t - t_{1}} \right)} \cdot {BG}_{{vl},1}} + {\left( {1 - {\gamma \left( {t - t_{1}} \right)}} \right) \cdot {BG}_{1}}}} \\{{BG}_{l,2} = {{{\gamma \left( {t - t_{1}} \right)} \cdot {BG}_{l,1}} + {\left( {1 - {\gamma \left( {t - t_{1}} \right)}} \right) \cdot {BG}_{1}}}} \\{{BG}_{{ml},2} = {{{\gamma \left( {t - t_{1}} \right)} \cdot {BG}_{{ml},1}} + {\left( {1 - {\gamma \left( {t - t_{1}} \right)}} \right) \cdot {BG}_{1}}}}\end{matrix} \right.$

-   -   where:        -   BG_(vl,2)=Very low blood glucose range limit or threshold            for a second amount of carbohydrate;        -   BG_(l,2)=Low blood glucose range limit or threshold for a            second amount of carbohydrate;        -   BG_(ml,2)=Medium-low blood glucose range limit or threshold            for a second amount of carbohydrate;        -   γ(x)=Carbohydrate absorption function for time interval x;        -   t=Current time when relative threshold is being calculated;        -   t₁=Time when first carbohydrate was consumed; and        -   BG₁=First blood glucose measurement.

In at least one embodiment of the present disclosure, the method furthercomprises receiving a third blood glucose measurement after the patientingested the second recommended amount of carbohydrate and calculatingwith the computing device a third recommended carbohydrate amount usingthe following formula

$\quad\left\{ \begin{matrix}{{BG}_{{vl},3} = {{{\gamma \left( {t - t_{2}} \right)} \cdot {BG}_{{vl},3}} + {\left( {1 - {\gamma \left( {t - t_{2}} \right)}} \right) \cdot {BG}_{2}} + {\frac{\gamma \left( {t - t_{2}} \right)}{\gamma \left( {t_{2} - t_{1}} \right)}\left( {{\gamma \left( {t - t_{1}} \right)} - 1} \right)\left( {{BG}_{2} - {BG}_{1}} \right)}}} \\{{BG}_{l,3} = {{{\gamma \left( {t - t_{2}} \right)} \cdot {BG}_{l,3}} + {\left( {1 - {\gamma \left( {t - t_{2}} \right)}} \right) \cdot {BG}_{2}} + {\frac{\gamma \left( {t - t_{2}} \right)}{\gamma \left( {t_{2} - t_{1}} \right)}\left( {{\gamma \left( {t - t_{1}} \right)} - 1} \right)\left( {{BG}_{2} - {BG}_{1}} \right)}}} \\{{BG}_{{ml},3} = {{{\gamma \left( {t - t_{2}} \right)} \cdot {BG}_{{ml},3}} + {\left( {1 - {\gamma \left( {t - t_{2}} \right)}} \right) \cdot {BG}_{2}} + {\frac{\gamma \left( {t - t_{2}} \right)}{\gamma \left( {t_{2} - t_{1}} \right)}\left( {{\gamma \left( {t - t_{1}} \right)} - 1} \right)\left( {{BG}_{2} - {BG}_{1}} \right)}}}\end{matrix} \right.$

where:

-   -   BG_(vl3)=Very low blood glucose range limit or threshold for a        third amount of carbohydrate (i.e., at time t3);    -   BG_(l,3)=Low blood glucose range limit or threshold for a third        amount of carbohydrate (i.e., at time t3);    -   BG_(ml,3)=Medium-low blood glucose range limit or threshold for        a third amount of carbohydrate (i.e., at time t3);    -   γ(x)=Carbohydrate absorption function for time interval x;    -   t=Current time when relative threshold is being calculated;    -   t_(n)=Time of n^(th) measurement since hypoglycemia; and    -   BG_(n)=n^(th) blood glucose measurement since hypoglycemia.

In at least one embodiment of the present disclosure, the method furthercomprises calculating subsequent amounts of carbohydrates bysuperimposing the effects of previous carbohydrate amounts.

In at least one embodiment of the present disclosure, the method furthercomprises calculating the very low blood glucose limit, the low bloodglucose limit, and the medium-low blood glucose limit based on no morethan the last three blood glucose measurements.

In at least one embodiment of the present disclosure, the method furthercomprises calculating with the computing device the carbohydrateabsorption function using the following formula

$\quad\left\{ \begin{matrix}{{\gamma (x)} = 0} & {{{if}\mspace{14mu} x} = 0} \\{{\gamma (x)} = {{{- 0.000125} \cdot x^{2}} + {0.022525 \cdot x} + 0.0019}} & {{{if}\mspace{14mu} 0} < x < 78} \\{{\gamma (x)} = 1} & {{{if}\mspace{14mu} x} \geq 78}\end{matrix} \right.$

-   -   where:        -   γ(x)=Carbohydrate absorption function; and        -   x=Time frame of interest (in minutes).

In at least one embodiment of the present disclosure, the method furthercomprises calculating with the computing device the carbohydrateabsorption function using the following formula

$\quad\left\{ \begin{matrix}{{\gamma (x)} = {{{- \frac{1}{t_{a}^{2}}}x^{2}} + {\frac{2}{t_{a}}x}}} & {{{if}\mspace{14mu} 0} \leq x \leq t_{a}} \\{{\gamma (x)} = 1} & {{{if}\mspace{14mu} x} > t_{a}}\end{matrix} \right.$

-   -   where:        -   γ(x)=Carbohydrate absorption function;        -   x=Time frame of interest (in minutes); and        -   t_(a)=Total carbohydrate absorption time.

In at least one embodiment of the present disclosure, the method furthercomprises calculating with the computing device the carbohydrateabsorption function using the following formula

$\left\{ \begin{matrix}{{\gamma (x)} = {\frac{1}{t_{a}}x}} & {{{if}\mspace{14mu} 0} \leq x \leq t_{a}} \\{{\gamma (x)} = 1} & {{{if}\mspace{14mu} x} > t_{a}}\end{matrix} \right.$

-   -   where:        -   γ(x)=Carbohydrate absorption function;        -   x=Time frame of interest (in minutes); and        -   t_(a)=Total carbohydrate absorption time.

In at least one embodiment of the present disclosure, the method furthercomprises calculating with the computing device the carbohydrateabsorption function using the following formula

γ(x)=1−e ^(ax)

-   -   where:        -   γ(x)=Carbohydrate absorption function;        -   x=Time frame of interest (in minutes); and        -   a=0.03.

In at least one embodiment of the present disclosure, the method furthercomprises calculating with the computing device the carbohydrateabsorption function using the following formula

γ(x)=1−e ^(−ax) ² ^(−bx)

-   -   where:        -   γ(x)=Carbohydrate absorption function;        -   x=Time frame of interest (in minutes);        -   a=0.0004; and        -   b=0.015.

In at least one embodiment of the present disclosure, the carbohydrateabsorption function is a linear function.

In at least one embodiment of the present disclosure, the carbohydrateabsorption function is a parabolic function.

In at least one embodiment of the present disclosure, the carbohydrateabsorption function is an exponential function.

In at least one embodiment of the present disclosure, the method furthercomprises receiving with the computing device a manual input that thepatient has the symptom of hypoglycemia.

In at least one embodiment of the present disclosure, the method furthercomprises determining automatically with the computing device that thepatient has the symptom of hypoglycemia.

In at least one embodiment of the present disclosure, said determiningautomatically includes analyzing results from a questionnaire to detecthypoglycemic symptoms with the computing device.

In at least one embodiment of the present disclosure, said determiningautomatically includes analyzing a video of the patient for thehypoglycemic symptoms with the computing device.

In at least one embodiment of the present disclosure, said determiningautomatically includes analyzing speech of the patient for thehypoglycemic symptoms with the computing device.

In at least one embodiment of the present disclosure, the computingdevice includes a glucose meter, a computer, an insulin pump, or acombination of the above.

BRIEF DESCRIPTION OF THE DRAWINGS

The features and advantages of the present disclosure, and the manner ofattaining them, will be more apparent and better understood by referenceto the following descriptions taken in conjunction with the accompanyingfigures, wherein:

FIG. 1 is a diagrammatic view of a blood glucose monitoring system,according to at least one embodiment of the present disclosure;

FIG. 2 is a block diagram of a computer used in the FIG. 1 system,according to at least one embodiment of the present disclosure;

FIG. 3 is a block diagram of a meter used in the FIG. 1 system,according to at least one embodiment of the present disclosure;

FIG. 4 is a block diagram of an insulin pump used the in the FIG. 1system, according to at least one embodiment of the present disclosure;

FIG. 5 is a flowchart showing the general phases of a method fordetecting and treating hypoglycemia, according to at least oneembodiment of the present disclosure;

FIG. 6 is a graph comparing five functions for modeling carbohydrateabsorption, according to at least one embodiment of the presentdisclosure;

FIG. 7 is a flowchart showing a method for detecting and treatinghypoglycemia, according to at least one embodiment of the presentdisclosure;

FIG. 8 is a graph displaying four blood glucose ranges used to compute afirst amount of carbohydrates (n_(BU,1)) at hypoglycemia detection time(t₁);

FIG. 9 is a graph displaying four ranges referring to a second bloodglucose measurement (BG₂) used to compute a second amount ofcarbohydrates (n_(BU,2)) in relation to time since the hypoglycemiausing a linear function when the first hypoglycemic blood glucosereading (BG₁) was 40 mg/dL;

FIG. 10 is a graph displaying four ranges referring to the second bloodglucose measurement (BG₂) used to compute the second amount ofcarbohydrates (n_(BU,2)) in relation to time since the hypoglycemiausing a parabolic function when the first hypoglycemic blood glucosereading (BG₁) was 40 mg/dL;

FIG. 11 is a graph displaying four ranges referring to the second bloodglucose measurement (BG₂) used to compute a second amount ofcarbohydrates (n_(BU,2)) in relation to time since the hypoglycemiausing a linear function when the first hypoglycemic blood glucosereading (BG₁) was 90 mg/dL;

FIG. 12 is a graph displaying four ranges referring to the second bloodglucose measurement (BG₂) used to compute the second amount ofcarbohydrates (n_(BU,2)) in relation to time since the hypoglycemiausing a parabolic function when the first hypoglycemic blood glucosereading (BG₁) was 90 mg/dL;

FIG. 13 is a graph displaying four ranges referring to a third bloodglucose measurement (BG₃) used to compute a third amount ofcarbohydrates (n_(BU,3)) in relation to time since the hypoglycemiausing a linear function when the first hypoglycemic blood glucosereading (BG₁) was 90 mg/dL and the second blood glucose reading (BG₂)was 40 mg/dL;

FIG. 14 is a graph displaying four ranges referring to the third bloodglucose measurement (BG₃) used to compute the third amount ofcarbohydrates (n_(BU,3)) in relation to time since the hypoglycemiausing a parabolic function when the first hypoglycemic blood glucosereading (BG₁) was 90 mg/dL and the second blood glucose reading (BG₂)was 40 mg/dL;

FIG. 15 is a graph displaying four ranges referring to a third bloodglucose measurement (BG₃) used to compute a third amount ofcarbohydrates (n_(BU,3)) in relation to time since the hypoglycemiausing a linear function when the first hypoglycemic blood glucosereading (BG₁) was 40 mg/dL and the second blood glucose reading (BG₂)was 90 mg/dL;

FIG. 16 is a graph displaying four ranges referring to the third bloodglucose measurement (BG₃) used to compute the third amount ofcarbohydrates (n_(BU,3)) in relation to time since the hypoglycemiausing a parabolic function when the first hypoglycemic blood glucosereading (BG1) was 40 mg/dL and the second blood glucose reading (BG₂)was 90 mg/dL; and

FIG. 17 is a flowchart showing a method for detecting and treatinghypoglycemia, according to at least one embodiment of the presentdisclosure.

DESCRIPTION OF THE SELECTED EMBODIMENTS

For the purposes of promoting an understanding of the principles of thepresent disclosure, reference will now be made to the embodimentsillustrated in the drawings, and specific language will be used todescribe the same. It will nevertheless be understood that no limitationof the scope of this disclosure is thereby intended. For instance,logical, mechanical, and electrical changes may be made withoutdeparting from the spirit and scope of the present disclosure.

Usual methods for hypoglycemia detection only monitor blood glucosemeasurements. Typical treatments for hypoglycemia includerecommendations of carbohydrate ingestion if the measured blood glucoselevel is below a specific threshold. Such a threshold is usually set bya health care provider and does not vary as a function of time. Commonmethods for treating hypoglycemia do not necessarily include follow upblood glucose measurements for the patient in order to verify thatpatient is no longer hypoglycemic. Moreover, the calculation ofcarbohydrate amounts in case of hypoglycemia are based on fixedthresholds for blood glucose concentrations assessments and do notconsider prior information, such as previous amounts of carbohydratesconsumed. Moreover, common hypoglycemia detection and treatmentmethodologies fail to consider delays between carbohydrate consumptionand changes in glucose levels. Questionable treatment recommendationscan occur if the blood glucose readings are measured in a small timeinterval.

In various methods of detecting and treating hypoglycemia as describedherein, method allows the detection of hypoglycemia by considering thepatient's feeling of hypoglycemia. This allows patient support to occurin the very early phase of hypoglycemia. In addition, the methodsupports the patient in the hypoglycemia recovery stage by recommendingthe ingestion of multiple carbohydrate amounts computed by using anoriginal model taking blood glucose dynamics and previous carbohydrateingestion into account.

As mentioned before, the method of detecting and treating hypoglycemiadescribed herein helps to reduce the length of or even eliminatehypoglycemic events as well as ensures that the hypoglycemia has beenresolved. The method includes three general phases, a detection phase, acarbohydrate computation phase, and a surveillance phase. In thedetection phase, the method not only considers blood glucosemeasurements but also whether the patient feels the onset ofhypoglycemia. This may allow treatment to occur earlier and at higherblood glucose levels, thereby minimizing the length of or even avoidinga hypoglycemia event altogether. For the carbohydrate computation phase,the recommended carbohydrate amount can be adjusted based on the amountof carbohydrates recently consumed by the individual and/or recent bloodglucose readings. The method also has a surveillance phase to determinewhether the specified treatment option has remedied the hypoglycemia oradditional treatment is required. The surveillance phase can include adelay so as to reduce the chance of making questionable recommendationsbased on glucose measurements being made too close together. Further,the surveillance and computation phases may in some instances repeatuntil the patient is no longer experiencing hypoglycemia.

An exemplary embodiment of a system 100 for performing the hypoglycemiadetection and treatment method is illustrated in FIG. 1. As shown, thesystem 100 includes a computer 102, a glucose meter 104, and an insulinpump 106. The computer 102 is used to collect and analyze data from theglucose meter 104 and/or the insulin pump 106. The glucose meter 104 isused to collect blood glucose readings from the patient, and the insulinpump 106 is used to deliver insulin to the patient. As depicted by thearrows in FIG. 1, the computer 102 is configured to communicate with theglucose meter 104 and the insulin pump 106 in any number of manners,such as through a wired and/or wireless connection.

In the illustrated embodiment, the computer 102 includes at least oneprocessor that executes software and/or firmware code stored in memoryof computer 102. The software/firmware code contains instructions that,when executed by the processor of computer 102, causes computer 102 toperform the functions described herein. For example, computer 102 mayhave various types of software, including but not limited to CareLink®Pro, DexCom DM® 3, and Abbott CoPilot® brand software to name just a fewexamples. Computer 102 may alternatively include one or moreapplication-specific integrated circuits (ASICs), field-programmablegate arrays (FPGAs), digital signal processors (DSPs), hardwired logic,or combinations thereof. While computer 102 is illustratively a personalcomputer, other suitable devices may be provided, such as, for example,desktop computers, laptop computers, computer servers, personal dataassistants (“PDA”), smart phones, cellular devices, tablet computers,infusion pumps, an integrated device including a glucose measurementengine and a PDA or cell phone, etc. Although computer 102 isillustrated as a single computing device, multiple computing devices maybe used together to perform the functions of computer 102 describedherein.

As depicted by the arrows in FIG. 1, the computer 102 is configured tocommunicate with the meter 104 and/or the pump 106 in any number ofmanners, such as through a wired and/or wireless connection. Suchwireless communications may be radio frequency (“RF”) or other suitablewireless frequency, in which the measured glucose results aretransmitted via electromagnetic waves. Bluetooth.RTM. is one exemplarytype of wireless RF communication system that uses a frequency ofapproximately 2.4 Gigahertz (GHz). Another exemplary type of wirelesscommunication scheme uses infrared light, such as the systems supportedby the Infrared Data Association® (IrDA®). Other suitable types ofwireless communication may be provided. The communication may beunidirectional (i.e., data is transmitted only from meter 104 tocomputer 102) or bidirectional (i.e., data is transmitted between meter104 and computer 102 in either direction). Furthermore, thecommunication may also facilitate communication between two or moredevices, such as between meter 104, computing device 102, pump 106, andother suitable devices or systems. In addition, a wired link mayalternatively be provided, such as, for example, a wired Ethernet link.Other suitable public or proprietary wired or wireless links may also beused. The connection may be used to transmit data such as blood glucosemeasurements or results from a process performed on blood glucosemeasurement data. The connection may also be used to configure theparameters or settings on meter 104 and/or the insulin pump 108.

In at least one embodiment, computer 102 is in communication with aremote computing device, such as at a caregiver's facility or a locationaccessible by a caregiver, and data (e.g., glucose data or otherphysiological information) is transferred between them. In thisembodiment, computer 102 and the remote device are configured totransfer physiological information through a data connection such as,for example, via the Internet, cellular communications, or the physicaltransfer of a memory device such as a diskette, USB key, compact disc,or other portable memory device.

In one particular example, the glucose meter 104 includes an ACCU-CHEK®Expert brand meter. The ACCU-CHEK® Expert brand meter is capable ofstoring glucose, meal, insulin, and other event information. All of thisinformation can be easily uploaded to the computer 102 where the datacan undergo further analysis and interpretation. It nevertheless shouldbe appreciate that other kinds of meters can be used.

The insulin pump 106 can be connected to the glucose meter 104 and/orthe computer 102. The connection may be used to transmit data from theblood glucose meter 104 and/or the computer 102 to the insulin pump 106or vice versa. For example, the electronic connection may also be usedto transmit instructions from the blood glucose meter 104 to the insulinpump 106 regarding one or more injections of insulin from the pump intothe patient. Additionally, the connection may transmit informationregarding past, present, or future injections or insulin levels from theinsulin pump 106 to the glucose meter 104 and/or the continuous glucosemonitoring meter 106. Similar to the electronic connection discussedabove, the connection between the blood glucose meter 104 and theinsulin pump 106 may be wired or wireless and may be the same or adifferent type of connection than the one between the meter 104 and thecomputer 102. It should be recognized that the system 100 in otherembodiments can include different components, combinations of othercomponents, and/or configured differently than is shown in FIG. 1.

FIG. 2 illustrates a block diagram of one example of the computer 102illustrated in FIG. 1. As shown, the computer 102 includes a processor202, memory 204, and/or an input/output (I/O) device(s) 206. Theprocessor 202 is used to process information and commands, and thememory 204 stores data, such as glucose readings, structured tests,various functions, and procedures. For instance, the processor 202 caninclude a microprocessor and/or other electronics that are configured toprocess data, and the memory 204 is used to store data on a permanent ortemporary basis.

The memory 204 is any suitable computer readable medium that isaccessible by the processor 202. The memory 204 may be a single storagedevice or multiple storage devices, may be located internally orexternally to computer 102, and may include both volatile andnon-volatile media. Further, the memory 204 may include one or both ofremovable and non-removable media. Exemplary memory 204 includesrandom-access memory (RAM), read-only memory (ROM), electricallyerasable programmable ROM (EEPROM), flash memory, CD-ROM, DigitalVersatile Disk (DVD) or other optical disk storage, a magnetic storagedevice, or any other suitable medium which is configured to store dataand which is accessible by computer 102.

The I/O device(s) 206 is used to enter data and provide information. TheI/O device 206 can include a tactile input, buttons, touch screens,displays, speakers, and/or printers, but it can also include other typesof I/O devices. It should be appreciated that the computer 102 caninclude other components and/or be configured differently in otherembodiments.

I/O device 206 in an exemplary embodiment may display the estimatedglucose state of the person and/or a predicted glucose state of theperson at some time in the future. The glucose state may include theestimated glucose level and/or the estimated rate-of-change of theglucose level. The displayed information may also include an estimate ofthe quality or uncertainty of the estimated glucose level. Moreover, thedisplayed information may include warnings, alerts, etc. regardingwhether the estimated or predicted glucose level of the person ishypoglycemic or hyperglycemic. For example, a warning may be issued ifthe person's glucose level falls below (or is predicted to fall below) apredetermined hypoglycemic threshold, such as 50 milligrams of glucoseper deciliter of blood (mg/dl). Computer 102 may also be configured totactilely communicate information or warnings to the person, such as forexample by vibrating.

FIG. 3 is a block diagram showing one example of the glucose meter 104with a biosensor 302 for analyzing a body fluid sample so as todetermine the blood glucose level. Depending on the type of meter, thebiosensor 302 can include a discrete test strip and/or continuousmonitoring probe. As illustrated, the meter 104 includes the processor202, memory 204, and an input/output (I/O) device(s) 206 of the typedescribed above. The processor 202 is used to process information andcommands for analyzing body fluid samples, and the memory 204 storesinformation, such as blood glucose measurements, and other information.

FIG. 4 illustrates a block diagram of one example of the insulin pump106 illustrated in FIG. 1. As shown, the insulin pump 106 includes aprocessor 202, memory 204, an input/output (I/O) device(s) 206, and apump mechanism 402. The processor 202 is used to process information andcommands, and the memory 204 stores data, various functions, andprocedures. The I/O device(s) 206, such as one or more buttons,keyboards, and displays, is used to enter data and provide informationas well as control the insulin pump 106. The pump mechanism 402 iscontrolled by the processor 202 so as to deliver the appropriate amountof insulin to the patient at the appropriate time.

The method of detecting and treating hypoglycemia will be initiallydescribed with reference to flowchart 500 in FIG. 5. As can be seen, theflowchart 500 shows the general phases of the method that includehypoglycemia detection 502, carbohydrate computation 504, andhypoglycemia surveillance 506 phases. During the detection phase 502,the glucose meter 104 is used to monitor the blood glucose levels of thepatient. In addition, via the I/O device 206 of the meter 104, thepatient can indicate whether they are feeling the effects ofhypoglycemia. For example, the patient can press a button on the meter104 when they feel the symptoms of hypoglycemia, such as feelingconfused, feeling shaky, having blurred vision, etc. Upon receiving anotification that the patient is feeling hypoglycemic, the meter 104 incertain embodiments will instruct the patient to take a blood glucosemeasurement or the meter 104 can automatically perform the blood glucosemeasurement. This allows the meter 104 to determine if a significanthypoglycemic event is occurring. Moreover, the blood glucose readingshelp with computing the amount of carbohydrates to consume in thecarbohydrate computation phase 504. If the measured blood glucosereadings fall below a specified threshold (BG_(hypo,detection)) and/orthe patient indicates having hypoglycemia symptoms, the meter 104proceeds to the carbohydrate computation phase 504. Otherwise, the meter104 continues in the detection phase 502 by monitoring for low bloodglucose levels and/or hypoglycemia symptoms in the patient. As mentionedbefore, by monitoring both the blood glucose levels of the patient andfor hypoglycemia symptoms of the patient, this method is able to detectand treat hypoglycemia at earlier stages of the condition. For example,the patient may notice that they are having hypoglycemia symptoms beforetheir blood glucose level drops below the threshold. Conversely, theblood glucose level of the patient may drop below the threshold beforethe patient experiences any symptoms of hypoglycemia. As a result, thepatient can be treated even before they are technically experiencinghypoglycemia.

Upon detection of hypoglycemia in stage 502, either by the blood glucosemeasurement or patient symptom route, the meter 104 proceeds to thecarbohydrate computation phase 504. For explanation purposes, the amountof carbohydrates will be expressed in bread units. A bread unit isgenerally equivalent to 12 grams of carbohydrates. It should beappreciated that other scales can be used to represent the amount ofcarbohydrates to ingest. The meter 104 in stage 504 can recommend to thepatient an initial amount of carbohydrate to consume (or not) based onthe measured blood glucose level or even other factors. For instance,the meter 104 can recommend that the patient consume a large amountcarbohydrates when well below the hypoglycemia threshold level andlesser amounts when above the threshold. These recommended carbohydrateamounts can be on a discrete or continuous scale. In another variation,the meter 104 in the carbohydrate computation phase 504 may consider theamount of recently consumed food, such as by questioning the patientabout meals recently consumed. Such recently consumed food may in atleast one embodiment be in a timeframe that is selected from the last 15minutes, the last 30 minutes, the last 1 hour, the last 2 hours, thelast 4 hours, the last 8 hours and the last 12 hours. In some instances,the patient may feel hypoglycemic but the blood glucose readingsindicate otherwise. In such a case, the meter 104 may indicate that thepatient does not need to consume any carbohydrates but may provide otherrecommendations, such as seeking additional medical treatment, or not.

After recommending the initial carbohydrate amount, the meter 104 checksto see if the hypoglycemia has been remedied in the hypoglycemiasurveillance phase 506. As mentioned before, the hypoglycemiasurveillance phase 506 includes a delay (e.g., 15 minutes) betweenconsecutive measurements so as to compensate for delays that naturallyoccur, like the delays in absorbing the carbohydrates as well as delaysbetween changes in blood plasma glucose concentration and tissue glucoseconcentration. During the hypoglycemia surveillance phase 506, the meter104 not only monitors the blood glucose level of the patient but alsohow the patient feels. For example, after 15 to 20 minutes fromrecommending the patient to ingest the first or initial carbohydrateamount, the meter 104 can instruct the patient to perform (orautomatically perform) a second blood glucose measurement (BG₂) as wellas question the patient as to how they feel via the I/O device 206. Ifthe patient is no longer feeling hypoglycemic and the second bloodglucose reading (BG₂) is at or above a target blood glucose level, themeter 104 then can consider the hypoglycemia as being remedied, and ifnecessary, return to the hypoglycemia detection phase 502.

In one variation, the hypoglycemia surveillance phase 506 ends when theblood glucose measurement (BG) is above a specified threshold(BG_(hypo,end)). Equation 1 below represents this test.

BG≥BG_(hypo,end)   Equation 1

-   -   where:        -   BG=Blood glucose measurement; and        -   BG_(hypo,end)=Threshold where hypoglycemia is considered            ended.

This threshold (BG_(hypo,end)) for ending the surveillance phase 506 istypically larger than the threshold used to detect the hypoglycemia(BG_(hypo,detection)). In one example, the threshold used to detect thehypoglycemia (BG_(hypo,detection)) is 70 mg/dl, and the threshold(BG_(hypo,end)) for ending the surveillance phase 506 is 100 mg/dl.

Alternatively or additionally, the surveillance phase 506 can end whenthe blood glucose reading (BG) exceeds a second, relative threshold(BG_(end,relative)) that varies depending on the amount of carbohydratespreviously consumed. When food is digested, it takes time for the foodto be adsorbed into the blood stream so as to effect blood glucosemeasurements. If the measured blood glucose level is above this second,relative threshold (BG_(end,relative)) at a specified time afterconsuming a previously recommended carbohydrate amount, it would beexpected that the blood glucose levels would continue to rise untileventually reaching in the near future the threshold where hypoglycemiais considered ended (BG_(hypo,end)). This test can be represented byEquation 2 below.

BG≥BG_(end,relative)   Equation 2

-   -   where:        -   BG=Blood glucose measurement; and        -   BG_(end,relative)=Relative threshold for ending the            surveillance phase.

In order to determine the relative threshold (BG_(end,relative)), a timedependent carbohydrate absorption function (γ(t)) is used to model theabsorption of the carbohydrates. The carbohydrate absorption function(γ(t)) is initially zero (i.e., γ(t)=0), and monotonically increasestoward one (i.e., γ(t→∞)=1).

FIG. 6 illustrates five different examples of this carbohydrateabsorption function (γ(t)) for modeling carbohydrate absorption overtime. It should be appreciated that these are just a few examples andother different functions can be used as well. As can be seen, all ofthe illustrated functions start initially having a zero (0) value whenthe carbohydrate is first consumed and approaches one (1) as timepasses. In other words, when the carbohydrate or food is first eaten,the body is unable to instantaneously absorb the food, but as timepasses, greater amounts of the food are absorbed, thereby increasing theblood glucose levels in the patient over time.

Model A in FIG. 6 is modeled by a function in which it is assumed all ofthe carbohydrates are completely absorbed in 78 minutes. Thecarbohydrate absorption function (γ(x)) for model A is shown in Equation3 below. For the equations below, the generic term “x” has been tosignify the particular time of interest because these functions can beused for different time intervals.

$\begin{matrix}{\quad\left\{ \begin{matrix}{{\gamma (x)} = 0} & {{{if}\mspace{14mu} x} = 0} \\{{\gamma (x)} = {{{- 0.000125} \cdot x^{2}} + {0.022525 \cdot x} + 0.0019}} & {{{if}\mspace{14mu} 0} < x < 78} \\{{\gamma (x)} = 1} & {{{if}\mspace{14mu} x} \geq 78}\end{matrix} \right.} & {{Equation}\mspace{14mu} 3}\end{matrix}$

-   -   where:        -   γ(x)=Carbohydrate absorption function; and        -   x=Time frame of interest (in minutes).

The carbohydrate absorption function (γ(x)) for model A can begeneralized to any polynomial expression, such as Equation 4 below.

γ=c ₀ +c ₁ ·x+c ₂ ·x ² +c ₃ ·x ³ + . . . +c _(n) ·x ^(n)   Equation 4

The absorption function (γ(x)) for model B in FIG. 6 is a parabolicfunction that considers a parameter for carbohydrate total absorptiontime (t_(a)). The carbohydrate absorption function (γ(x)) for model B isshown in Equation 5 below.

$\begin{matrix}{\quad\left\{ \begin{matrix}{{\gamma (x)} = {{{- \frac{1}{t_{a}^{2}}}x^{2}} + {\frac{2}{t_{a}}x}}} & {{{if}\mspace{14mu} 0} \leq x \leq t_{a}} \\{{\gamma (x)} = 1} & {{{if}\mspace{14mu} x} > t_{a}}\end{matrix} \right.} & {{Equation}\mspace{14mu} 5}\end{matrix}$

-   -   where:        -   γ(x)=Carbohydrate absorption function;        -   x=Time frame of interest (in minutes); and        -   t_(a)=Total carbohydrate absorption time.

Model C in FIG. 6 is a linear carbohydrate absorption function (γ(x)) asrepresented by Equation 6 below.

$\begin{matrix}\left\{ \begin{matrix}{{\gamma (x)} = {\frac{1}{t_{a}}x}} & {{{if}\mspace{14mu} 0} \leq x \leq t_{a}} \\{{\gamma (x)} = 1} & {{{if}\mspace{14mu} x} > t_{a}}\end{matrix} \right. & {{Equation}\mspace{14mu} 6}\end{matrix}$

-   -   where:        -   γ(x)=Carbohydrate absorption function;        -   x=Time frame of interest (in minutes); and        -   t_(a)=Total carbohydrate absorption time.

Model D in FIG. 6 is an exponential carbohydrate absorption function(γ(x)) as represented by Equation 7 below.

γ(x)=1−e ^(−a·x)   Equation 7

-   -   where:        -   γ(x)=Carbohydrate absorption function;        -   x=Time frame of interest (in minutes); and        -   a=0.03.

Model E in FIG. 6 is a second exponential carbohydrate absorptionfunction (γ(x)) as represented by Equation 8 below.

γ(x)=1−e ^(−a·x) ² ^(−bx)   Equation 8

-   -   where:        -   γ(x)=Carbohydrate absorption function;        -   x=Time frame of interest (in minutes);        -   a=0.0004; and        -   b=0.015.

Returning to FIG. 5, based on the carbohydrate absorption function(γ(x)) used, the meter 104 is able to calculate the relative threshold(BG_(end,relative)) so as to determine whether the hypoglycemia has beenproperly addressed or if additional treatment (e.g., carbohydrateingestion) is required. If a carbohydrate amount has been ingested onlyonce since hypoglycemia detection, then the relative threshold(BG_(end,relative)) can be calculated using Equation 9 below.

BG_(end,relative)=γ(t−t ₁)·BG_(hypo,end)+(1−γ(t−t ₁))·BG₀   Equation 9

-   -   where:        -   BG_(end,relative)=Relative threshold for ending the            surveillance phase;        -   BG_(hypo,end)=Threshold where hypoglycemia is considered            ended;        -   γ(x)=Carbohydrate absorption function for time interval x;    -   t=Current time when relative threshold is being calculated;        -   t₁=Time when first carbohydrate recommended or consumed; and        -   BG₀=Original blood glucose measurement (i.e., when            hypoglycemia was detected).

When carbohydrates have been ingested twice since hypoglycemiadetection, then the relative threshold (BG_(end,relative)) can becalculated using Equation 10 below.

$\begin{matrix}{{BG}_{{end},{relative}} = {{{\gamma \left( {t - t_{2}} \right)} \cdot {BG}_{{hypo},{end}}} + {\left( {1 - {\gamma \left( {t - t_{2}} \right)}} \right) \cdot {BG}_{2}} + {\frac{\gamma \left( {t - t_{2}} \right)}{\gamma \left( {t_{2} - t_{1}} \right)}\left( {{\gamma \left( {t - t_{1}} \right)} - 1} \right)\left( {{BG}_{2} - {BG}_{1}} \right)}}} & {{Equation}\mspace{14mu} 10}\end{matrix}$

-   -   where:        -   BG_(end,relative)=Relative threshold for ending the            surveillance phase;        -   BG_(hypo,end)=Threshold where hypoglycemia is considered            ended;        -   γ(x)=Carbohydrate absorption function for time interval x;        -   t=Current time when relative threshold is being calculated;        -   t_(n)=Time of n^(th) measurement since hypoglycemia; and        -   BG_(n)=n^(th) blood glucose measurement since hypoglycemia.

When three or more carbohydrate ingestion events occur sincehypoglycemia detection, the relative threshold (BG_(end,relative)) iscalculated by superimposing the effects of the multiple carbohydrateingestions.

When hypoglycemia symptoms persist and/or the blood glucose levels arestill not ideal, such as when the blood glucose measurements fail theend threshold (BG_(hypo,end)) and the relative threshold(BG_(end,relative)) tests, the meter 104 proceeds again to thecarbohydrate computation phase 504. For the second and subsequentcarbohydrate calculations in stage 504, the meter 104 to considersprevious blood glucose measurements along with previously recommendedand/or consumed carbohydrate amounts. The rate of change in the bloodglucose level can also be considered along with other factors, like thetime difference between the measurements. As noted before, conventionalmethods for carbohydrate computation in case of hypoglycemia are basedon a fixed threshold for blood glucose assessment and do not considerprior information. Questionable treatment recommendations can occur forexample when blood glucose measurements are made too close together orfail to consider the amount of carbohydrates previously consumed by thepatient. For instance, if the blood glucose increase followingcarbohydrate ingestion (e.g., blood glucose is measured after 15minutes) is smaller than expected or even worse if blood glucose doesnot increase at all, then additional carbohydrates must be recommendedwhatever the carbohydrate absorption model. On the other hand ignoringprevious carbohydrate ingestion and applying the same carbohydratecomputation process at each blood glucose measurement can lead to anexcess of carbohydrate ingested by the patient leading to poor glucosecontrol.

For example, if the blood glucose level of the patient (BG₁) wasinitially 45 mg/dl, a conventional method would diagnose the patient asexperiencing hypoglycemia because the blood glucose level was below thetraditional 60 mg/dl threshold. Following the conventional protocol, thepatient would be instructed to consume a first carbohydrate amount tocounteract the hypoglycemia. Staying with this hypothetical, 15 minuteslater a second blood glucose measurement (BG₂) of 55 mg/dl is measured.Using a conventional treatment protocol, given that this second bloodglucose measurement (BG₂) is still below the 60 mg/dl limit, the patientwould again be instructed to consume a second amount of carbohydrate.However, consuming this second carbohydrate amount might result inovershooting the target blood glucose range some minutes or a few hourslater. This traditional approach failed to consider the 10 mg/dlincrease between the first (BG₁) and second (BG₂) blood glucosereadings. Based on this increase in the blood glucose level, it shouldbe expected that the blood glucose level would continue to increase dueto the initial carbohydrate ingestion, and the target blood glucoselevel might be possibly reached without any need of additionalcarbohydrate ingestion. The method described herein takes previousinformation (e.g., previous blood glucose measurements and carbohydrateingestion) into account to compute in stage 504 additional carbohydrateamount recommendations more accurately.

FIG. 7 is a flowchart 700 for one variation of the method for detectingand treating hypoglycemia, and FIG. 17, which will be discussed later,shows another variation of the method. Among other things, the methodsillustrated by FIGS. 7 and 17 differ in how the carbohydrate computationoccurs.

As should be recognized, the method depicted by the flow chart 700 inFIG. 7 shares the same general phases as those previously described withrespect to the flowchart 500 in FIG. 5. During the hypoglycemiadetection phase 502, the current blood glucose measurement (BG) for thepatient can be manually entered into the meter 104 in stage 702 orautomatically entered into the meter 104 in stage 704. The meter 104 instage 706 compares the current blood glucose reading (BG) to anestablished threshold for hypoglycemia (BG_(hypo,detection)). In theillustrated example, the threshold for hypoglycemia(BG_(hypo,detection)) is 70 mg/dl, but it should be recognized that thisthreshold can be different in other variations. When the current bloodglucose reading (BG) is above the threshold for hypoglycemia(BG_(hypo,detection)), then no hypoglycemia is apparently occurring, andthe meter 104 proceeds to stage 708 where the routine ends. Of course,the meter 104 at stage 708 can start over again monitoring forhypoglycemia (i.e., proceed back to stage 702, 704, etc.). On the otherhand, when the current blood glucose reading (BG) is at or below thethreshold for hypoglycemia (BG_(hypo,detection)), the meter 104 proceedsto the carbohydrate computation phase 504 so as to compute the first orinitial carbohydrate amount (n_(BU,1)) to correct the hypoglycemia, ifneeded.

As noted before, the hypoglycemia detection phase 502 also includes ahypoglycemia symptom component. By considering whether the patient isfeeling the initial symptoms of hypoglycemia allows the meter 104 totreat the hypoglycemia earlier than by relying on the blood glucosemeasurements alone. The patient can indicate feeling hypoglycemiasymptoms in stage 710. In one example, the patient notifies the meter104 that they are feeling the effects of hypoglycemia through the I/Odevice 206 (e.g., by pressing a dedicated button). Then the patient isrequested to measure their current blood glucose level in stage 712.Note again that treatment of the hypoglycemia can be possiblyrecommended at blood glucose values much higher than blood glucosethreshold mentioned previously.

After either determining the blood glucose level is at or below thethreshold (stage 706) or the patient indicates a feeling of hypoglycemia(stage 712), the meter 104 proceeds to calculate the recommendedcarbohydrate amount to treat the hypoglycemia based on the current bloodglucose level of the patient (phase 504 in FIG. 5). In this example, thecarbohydrate amounts are divided into three levels, small(n_(BU,small)), medium (n_(BU,medium)), and large (n_(BU,large)). Asnoted before, the carbohydrate amounts are typically expressed in termsof bread units, and a bread unit is equivalent to 12 grams of bread.Equation 11 below shows how the carbohydrate amounts are calculated forthese three levels.

$\begin{matrix}{\quad\left\{ \begin{matrix}{n_{{BU},{small}} = {f_{n}\left( {n_{{BU},{TDD}} + n_{{BU},{fainting}}} \right)}} \\{n_{{BU},{medium}} = {f_{n}\left( {n_{{BU},{TDD}} + n_{{BU},{fainting}} + 1} \right)}} \\{n_{{BU},{large}} = {f_{n}\left( {n_{{BU},{TDD}} + n_{{BU},{fainting}} + 2} \right)}}\end{matrix} \right.} & {{Equation}\mspace{14mu} 11}\end{matrix}$

-   -   where:        -   n_(BU,small)=Small amount of carbohydrate;        -   n_(BU,medium)=Medium amount of carbohydrate;        -   n_(BU,large)=Large amount of carbohydrate;        -   f_(n)=Normalization factor based on patient weight;        -   n_(BU,fainting)=Risk of fainting additional bread unit; and        -   n_(BU,TDD)=Additional bread unit recommended for patients            with a total daily dose (TDD) of insulin ≤30 UI.

In equation 11 above, additional carbohydrate amounts are recommendedfor patients with a total daily dose (TDD) of insulin smaller or equalto 30 units of insulin. Equation 12 shows this adjustment of adding oneadditional bread unit for such a patient.

$\begin{matrix}\left\{ \begin{matrix}{n_{{BU},{TDD}} = 1} & {{{if}\mspace{14mu} {TDD}} \leq {30\mspace{11mu} {UI}}} \\{n_{{BU},{TDD}} = 0} & {otherwise}\end{matrix} \right. & {{Equation}\mspace{14mu} 12}\end{matrix}$

Regarding equation 11, additional carbohydrate amounts are recommendedfor patients having a history of fainting during hypoglycemia. Equation13 shows this adjustment of adding one additional bread unit when thepatient has a fainting risk.

$\begin{matrix}\left\{ \begin{matrix}{n_{{BU},{fainting}} = 1} & {{for}\mspace{14mu} {patients}\mspace{14mu} {with}\mspace{14mu} a\mspace{14mu} {history}\mspace{14mu} {of}\mspace{14mu} {unconsciousness}} \\{n_{{BU},{fainting}} = 0} & {otherwise}\end{matrix} \right. & {{Equation}\mspace{14mu} 13}\end{matrix}$

As noted before, the normalization factor (f_(n)) is used to adjust therecommended carbohydrate amount based on the weight of the patient.Equation 14 below represents how this factor is calculated.

$\begin{matrix}{f_{n} = \frac{M - {0.5 \cdot M_{OW}}}{70}} & {{Equation}\mspace{14mu} 14}\end{matrix}$

-   -   where:        -   M=patient weight (kilograms); and        -   M_(OW)=patient overweight (kilograms).

Whether a patient is overweight depends on a number of factors,including the weight (M) and height (H) of the patient. Equation 15below provides an example to determine the patient overweight factor(M_(OW)).

$\begin{matrix}{M_{OW} = \left\{ \begin{matrix}0 & {{{{if}\mspace{14mu} M} - H + 100} < 0} \\{M - H + 100} & {{{{if}\mspace{14mu} M} - H + 100} \geq 0}\end{matrix} \right.} & {{Equation}\mspace{14mu} 15}\end{matrix}$

-   -   where:        -   H=Height of the patient (centimeters);        -   M=patient weight (kilograms); and        -   M_(OW)=patient overweight (kilograms).

It should be appreciated that the physician or other health careprovider can adjust these recommended carbohydrate amounts so as tocustomize the amounts for the particular needs of the patient.

Looking again at FIG. 7, the meter 104 calculates the first amount ofcarbohydrate (n_(BU,1)) right after hypoglycemia is detected (at timet₁). The first amount of carbohydrate (n_(BU,1)) is obtained bycomparing the first blood glucose measurement (BG₁), which was madeduring stages 706 or 712, with the very low (BG_(vl,1)), low (BG_(l,1)),and medium-low (BG_(ml,1)) blood glucose range limits. In one example,the very low (BG_(vl,1)), low (BG_(l,1)), and medium-low (BG_(ml,1))blood glucose range limits are 60 mg/dl, 100 mg/dl, and 140 mg/dl,respectively. However, these limits can be different in other examples.In for example the flowchart 700 in FIG. 7, the very low (BG_(vl,1)),low (BG_(l,1)), and medium-low (BG_(ml,1)) blood glucose range limitsare respectively 60 mg/dl, 100 mg/dl, and 120 mg/dl. Equation 16 belowshows how the first amount of carbohydrate (n_(BU,1)) is determinedbased on these glucose ranges limits.

$\begin{matrix}{n_{{BU},1} = \left\{ \begin{matrix}0 & {{{if}\mspace{14mu} {BG}_{{ml},1}} < {BG}_{1}} \\n_{{BU},{small}} & {{{if}\mspace{14mu} {BG}_{l,1}} < {BG}_{1} \leq {BG}_{{ml},1}} \\n_{{BU},{medium}} & {{{if}\mspace{14mu} {BG}_{{vl},1}} < {BG}_{1} \leq {BG}_{l,1}} \\n_{{BU},{large}} & {{{if}\mspace{14mu} {BG}_{1}} \leq {BG}_{{vl},1}}\end{matrix} \right.} & {{Equation}\mspace{14mu} 16}\end{matrix}$

-   -   where:        -   n_(BU,1)=First amount of carbohydrate computed right at            hypoglycemia detection (i.e., at time t₁);        -   n_(BU,small)=Small amount of carbohydrate;        -   n_(BU,medium)=Medium amount of carbohydrate;        -   n_(BU,large)=Large amount of carbohydrate;        -   BG₁=Blood glucose measurement at hypoglycemia detection            (i.e., at time t₁);        -   BG_(ml,1)=Medium-low blood glucose range limit or threshold            for a first amount of carbohydrate (i.e., at time t₁);        -   BG_(l,1)=Low blood glucose range limit or threshold for a            first amount of carbohydrate (i.e., at time t₁); and        -   BG_(vl,1)=Very low blood glucose range limit or threshold            for a first amount of carbohydrate (i.e., at time t₁).

It should be appreciated that the meter 104 determines the small(n_(BU,small)), medium (n_(BU,medium)), and large (n_(BU,large))carbohydrate amounts based on the equations 11-15 as was discussedabove. FIG. 8 illustrates how the first amount of carbohydrate iscomputed based on the first blood glucose reading (BG₁) taken at thetime (t₁) when hypoglycemia was first detected. Since at this stage noprevious carbohydrates were consumed close to the hypoglycemia event,the ranges separating the various carbohydrate amounts are constant overtime, because the model does not include increases due to anycarbohydrate absorption. In other words, recommended ranges for thesmall (n_(BU,small)), medium (n_(BU,mednim)), and large (n_(BU,large))carbohydrate amounts (as well as no carbohydrates) are constant overtime for the initial calculation. For example, when the first bloodglucose reading (BG₁) is 80 mg/dl, the recommended medium carbohydrateamount (n_(BU,medium)) is the same at 25 and 55 minutes after detectionof the hypoglycemia.

Looking now at stage 714 in FIG. 7, the meter 104 determines whether thefirst blood glucose measurement (BG₁) was at or below the very low(BG_(vl,1)) blood glucose limit, which in this example is 60 mg/dl. Whenthe first blood glucose measurement (BG₁) is at or below this limit, themeter 104 calculates the large carbohydrate amount (n_(BU,large)) neededto be ingested by the patient based on equations 11-15. It should berecognized that lower blood glucose levels typically require higheramounts of carbohydrates be ingested in order to address hypoglycemia ascompared to higher blood glucose levels. Once the large carbohydrateamount (n_(BU,large)) is calculated in stage 716, the meter 104 via theI/O device 206 provides to the patient and/or the health care providerthe recommended large carbohydrate amount (n_(BU,large)) to ingest instage 718. For example, the meter 104 can display to the patient thatthe patient should consume 3 bread units of carbohydrates to address thecurrent condition.

When the first blood glucose measurement (BG₁) is greater than the verylow (BG_(vl,1)) blood glucose limit, the meter 104 in stage 720determines if the first blood glucose measurement (BG₁) is less than orequal to the low blood glucose limit (BG_(l,1)), which in FIG. 7 is 100mg/dl. If the first blood glucose measurement (BG₁) is at or below thislimit, the meter 104 calculates in stage 722 the medium or intermediatecarbohydrate amount (n_(BU,medium)) needed to be ingested by the patientbased on equations 11-15. Once the medium carbohydrate amount(n_(BU,mednim)) is calculated in stage 722, the meter 104 via the I/Odevice 206 provides to the patient and/or the health care provider therecommended medium carbohydrate amount (n_(BU,medium)) to ingest instage 718. For instance, the meter 104 can display to the patient thatthe patient should consume 2 bread units of carbohydrates to address thecurrent situation.

In stage 720, if the first blood glucose measurement (BG₁) is greaterthan the low (BG_(l,1)) blood glucose limit, the meter 104 proceeds tostage 724 to determine if the first blood glucose measurement (BG₁) isless than or equal to the medium-low (BG_(ml,1)) blood glucose rangelimit, which in the illustrated example is 120 mg/dl. If the first bloodglucose measurement (BG₁) is at or below this limit, the meter 104calculates in stage 726 the small carbohydrate amount (n_(BU,small))needed to be ingested by the patient. Once the small carbohydrate amount(n_(BU,small)) is calculated in stage 726, the meter 104 via the I/Odevice 206 provides to the patient and/or the health care provider therecommended medium carbohydrate amount (n_(BU,medium)) to ingest instage 718. For instance, the meter 104 can display to the patient thatthe patient should consume 1 bread unit of carbohydrates to address thecurrent situation. When the first blood glucose measurement (BG₁) isgreater than the medium-low blood glucose range limit (BG_(ml,1)), themeter proceeds to stage 728 and displays any recommendations (or none atall) via the I/O device 206, and the analysis ends in stage 708.

After instructing the patient to ingest a particular amount ofcarbohydrates in stage 718, the meter 104 proceeds to the surveillancephase 506. As discussed before, upon ingesting the blood glucose leveldoes not instantaneously rise. Instead, after the first carbohydrateamount is ingested, the blood glucose level is expected to graduallyincrease to the target, end of surveillance threshold (BG_(hypo,end)).If the second blood glucose reading (BG₂) is taken too close to thefirst measurement (BG₁), the analysis on whether the hypoglycemia hasbeen addressed can be inaccurate. To address this issue, the methodincludes a delay between measurements in stage 730. In the illustratedexample, the delay is 15 minutes, but it can be different in otherexamples (e.g., 10 or 20 minutes). After the delay, the meter 104 instage 732 instructs the patient to perform a second blood glucose testso as to collect a second blood glucose reading (BG₂) or the meter 104automatically performs the test. The meter 104 also asks the patient viathe I/O device 206 whether the patient is feeling any symptomsassociated with hypoglycemia in stage 734.

In stage 736, the meter 104 evaluates whether the patient indicatedhaving a feeling of hypoglycemia. When there is no feeling or symptomsof hypoglycemia, the meter proceeds to stage 738 so as to evaluate thesecond blood glucose measurement (BG₂) against a target level fordetermining whether the surveillance phase 506 needs to continue.Equation 1 above provides an example of how the end of surveillancethreshold (BG_(hypo,end)) is evaluated in stage 738. When the meter 104determines the second blood glucose reading (BG₂) is above this targetor end of surveillance threshold (BG_(hypo,end)), the meter 104considers the hypoglycemia problem to be solved in stage 740 and canindicate as such via the I/O device 206. With the hypoglycemia problemsolved, the meter 104 proceeds to end the analysis in stage 708.

On the other hand, when a patient indicates as having symptoms ofhypoglycemia in stage 736 or the second blood glucose reading (BG₂) isnot above the end of surveillance threshold (BG_(hypo,end)) in stage738, the meter 104 then computes a second amount of carbohydrate toingest starting in stage 742. Additional carbohydrates are recommendedif the blood glucose level has not increased enough after the firstcarbohydrate ingestion. When the single, first amount of carbohydrate(n_(BU,1)) was already ingested, the second very low (BG_(vl,2)), secondlow (BG_(l,2)), and second medium-low (BG_(ml,2)) blood glucose rangelimits used to calculate the new, second amount of carbohydrate(n_(BU,2)) can possibly be different from the first very low(BG_(vl,1)), first low (BG_(l,1)), and first medium-low (BG_(ml,1))blood glucose limits. At second measurement time (t₂), the second verylow (BG_(vl,2)), second low (BG_(l,2)), and second medium-low(BG_(ml,2)) blood glucose limits depend upon the first (BG₁) and second(BG₂) blood glucose measurements as well as the time elapsed since theprevious carbohydrate ingestion (Δt_(2,1)=t₂−t₁). Equation 17 shows anexample of how these second limits are calculated.

$\quad\begin{matrix}\left\{ \begin{matrix}{{BG}_{{vl},2} = {{{\gamma \left( {t - t_{1}} \right)} \cdot {BG}_{{vl},1}} + {\left( {1 - {\gamma \left( {t - t_{1}} \right)}} \right) \cdot {BG}_{1}}}} \\{{BG}_{l,2} = {{{\gamma \left( {t - t_{1}} \right)} \cdot {BG}_{l,1}} + {\left( {1 - {\gamma \left( {t - t_{1}} \right)}} \right) \cdot {BG}_{1}}}} \\{{BG}_{{ml},2} = {{{\gamma \left( {t - t_{1}} \right)} \cdot {BG}_{{ml},1}} + {\left( {1 - {\gamma \left( {t - t_{1}} \right)}} \right) \cdot {BG}_{1}}}}\end{matrix} \right. & {{Equation}\mspace{14mu} 17}\end{matrix}$

-   -   where:        -   BG_(vl,2)=Very low blood glucose range limit or threshold            for a second amount of carbohydrate (i.e., at time t₂);        -   BG_(l,2)=Low blood glucose range limit or threshold for a            second amount of carbohydrate (i.e., at time t₂);        -   BG_(ml,2)=Medium-low blood glucose range limit or threshold            for a second amount of carbohydrate (i.e., at time t₂);        -   γ(x)=Carbohydrate absorption function for time interval x;        -   t=Current time when relative threshold is being calculated;        -   t₁=Time when first carbohydrate was consumed; and        -   BG₁=First blood glucose measurement (i.e., when hypoglycemia            was detected).

Based on the limits calculated in equation 17 above, the second amountof carbohydrate (n_(BU,2)) to ingest can be calculated through equation18.

$\begin{matrix}{n_{{BU},2} = \left\{ \begin{matrix}0 & {{{if}\mspace{14mu} {BG}_{{ml},2}} < {BG}_{2}} \\n_{{BU},{small}} & {{{if}\mspace{14mu} {BG}_{l,2}} < {BG}_{2} \leq {BG}_{{ml},2}} \\n_{{BU},{medium}} & {{{if}\mspace{14mu} {BG}_{{vl},2}} < {BG}_{2} \leq {BG}_{l,2}} \\n_{{BU},{large}} & {{{if}\mspace{14mu} {BG}_{2}} \leq {BG}_{{vl},2}}\end{matrix} \right.} & {{Equation}\mspace{14mu} 18}\end{matrix}$

-   -   where:        -   n_(BU,2)=Second amount of carbohydrate to ingest (i.e., at            time t₂);        -   n_(BU,small)=Small amount of carbohydrate;        -   n_(BU,medium)=Medium amount of carbohydrate;        -   n_(BU,large)=Large amount of carbohydrate;        -   BG₂=Second blood glucose measurement (i.e., at time t₂);

Again, it should be appreciated that the meter 104 determines the small(n_(BU,small)), medium (n_(BU,medium)), and large (n_(BU,large))carbohydrate amounts based on the equations 11-15 as was discussedabove. Of course, the physician or other health care provider can adjustthese recommended carbohydrate amounts so as to customize the amountsfor the particular needs of the patient.

FIGS. 9, 10, 11, and 12 illustrate how the second carbohydrate amountsare determined with different absorption models having different initialconditions. In these graphs, the second amount of carbohydrate(n_(BU,2)) depends on the first (BG₁) and second (BG₂) blood glucosemeasurements respectively obtained at the first measurement time (t₁)when hypoglycemia was detected and the current, second measurement time(t₂).

Looking at FIGS. 9 and 10, both are graphs of four ranges of the secondblood glucose measurement (BG₂) displayed as a function of time sincethe hypoglycemic event (t). In both graphs of FIGS. 9 and 10, the firstblood glucose value (BG₁) was 40 mg/dl (at t₁=0). The first very low(BG_(vl,1)), first low (BG_(l,1)), and first medium-low (BG_(ml,1))blood glucose limits in both examples respectively equal 60, 100, and140 mg/dl. As can be seen in both graphs, the second very low(BG_(vl,2)), second low (BG_(l,2)), and second medium-low (BG_(ml,2))blood glucose limits all are initially equal to 40 mg/dl and then slowlyincrease to the 60, 100, and 140 mg/dl limits in a 90 minute time window(t_(a)) following the initial ingestion of the first carbohydrate amountwhen the hypoglycemia was first detected. The carbohydrate absorptionfunction (γ(x)) in FIG. 9 is based on linear absorption model C as wasformulated in equation 6 above and illustrated in FIG. 6. In contrast,the carbohydrate absorption function (γ(x)) in FIG. 10 is based onparabolic absorption model B as was formulated in equation 5 above andillustrated in FIG. 6. As can be seen in both graphs, the secondcarbohydrate amount (n_(BU,2)) is smaller or even zero when the secondblood glucose measurement (BG₂) is considerably higher than the first,40 mg/dl measurement (BG₁). For example, when the second blood glucosemeasurement (BG₂) in FIG. 9 is 80 mg/dl 15 minutes after thehypoglycemia being detected, no carbohydrates are required.

The graph FIG. 11 is similar to the graph in FIG. 9 in that thecarbohydrate absorption function (γ(x)) in FIG. 11 is based on the samelinear absorption model C as was formulated in equation 6 above. Thegraph in FIG. 12 is similar to the graph in FIG. 10 by that thecarbohydrate absorption function (γ(x)) in FIG. 12 is based on the sameparabolic absorption model B as was formulated in equation 5 above.However, the graphs in FIGS. 11 and 12 differ from those in FIGS. 9 and10 by the fact that the first blood glucose measurement (BG₁) in FIGS.11 and 12 are 90 mg/dl, rather than the 40 mg/dl first blood glucosemeasurement in FIGS. 9 and 10. Like before, the first very low(BG_(vl,1)), first low (BG_(l,1)), and first medium-low (BG_(ml,1))blood glucose limits in FIGS. 11 and 12 respectively equal 60, 100, and140 mg/dl. As can be seen in both graphs, the second very low(BG_(vl,2)), second low (BG_(l,2)), and second medium-low (BG_(ml,2))blood glucose limits all are initially equal to 40 mg/dl and then slowlyincrease to the 60, 100, and 140 mg/dl limits in a 90 minute time window(t_(a)).

Referring again to FIG. 7, when a patient indicates having symptoms ofhypoglycemia in stage 736 or the second blood glucose reading (BG₂) isnot above the end of surveillance threshold (BG_(hypo,end)) in stage738, the meter 104 then computes a second amount of carbohydrate toingest (phase 504). In stage 742, the meter 104 determines whether thesecond blood glucose measurement (BG₂) was less than or equal to thesecond very low (BG_(vl,2)) blood glucose limit as was calculated in themanner previously discussed (see, equation 17). When the second bloodglucose measurement (BG₂) is at or below this limit, the meter 104calculates the large carbohydrate amount (n_(BU,large)) needed to beingested by the patient in stage 744 based on equations 11-15. Once thelarge carbohydrate amount (n_(BU,large)) is calculated in stage 744, themeter 104 via the I/O device 206 provides to the patient and/or thehealth care provider the recommended large carbohydrate amount(n_(BU,large)) to ingest in stage 746. For example, the meter 104 candisplay to the patient that the patient should consume 3 bread units ofcarbohydrates to address the current condition.

When the second blood glucose measurement (BG₂) is greater than thesecond very low (BG_(vl,2)) blood glucose limit, the meter 104 in stage748 determines if the second blood glucose measurement (BG₂) is lessthan or equal to the low blood glucose limit (BG_(l,1)), which in FIG. 7is 100 mg/dl. If the second blood glucose measurement (BG₂) is at orbelow this limit, the meter 104 calculates in stage 750 the medium orintermediate carbohydrate amount (n_(BU,medium)) needed to be ingested.Once the medium carbohydrate amount (n_(BU,medium)) is calculated instage 750, the meter 104 via the I/O device 206 provides to the patientand/or the health care provider the recommended medium carbohydrateamount (n_(BU,medium)) to ingest in stage 746. For instance, the meter104 can display to the patient that the patient should consume 2 breadunits of carbohydrates to address the current situation.

If in stage 748 the second blood glucose measurement (BG₂) is greaterthan the second low (BG_(l,2)) blood glucose limit, the meter 104proceeds to stage 752 to determine if the second blood glucosemeasurement (BG₂) is less than or equal to medium-low (BG_(ml,1)) bloodglucose range limit. If the second blood glucose measurement (BG₂) is ator below this limit, the meter 104 calculates in stage 754 the smallcarbohydrate amount (n_(BU,small)) needed to be ingested by the patient.Once the small carbohydrate amount (n_(BU,small)) is calculated in stage754, the meter 104 via the I/O device 206 provides to the patient and/orthe health care provider the recommended medium carbohydrate amount(n_(BU,medium)) to ingest in stage 746. For instance, the meter 104 candisplay to the patient that the patient should consume 1 bread unit ofcarbohydrates to address the current situation. It should be noted thatthe blood glucose values (“BG”) and threshold limits (“BG_th1”,“BG_th2”, “BG_th3”) are referenced in a generic sense in stages 742,748, and 752, because the method may require the calculation ofadditional carbohydrate amounts over more than two carbohydrate amounts.

As noted before with respect to equation 2, the surveillance phase 506can end when the blood glucose reading (BG) exceeds a second, relativethreshold (BG_(end,relative)) that varies depending on the amount ofcarbohydrates previously consumed. For instance in the flowchart 700 ofFIG. 7, when the second blood glucose measurement (BG₂) is greater thanthe second medium-low blood glucose range limit (BG_(ml,2)), the meterproceeds to stage 756 and displays any recommendations (or none at all)via the I/O device 206, and the analysis ends in stage 708.

After instructing the patient to ingest a particular amount ofcarbohydrates in stage 746, the meter 104 continues with thesurveillance phase 502 by proceeding to the test delay stage 730. Atthat point, the surveillance and carbohydrate amount computations cancontinue for 3 or even more measurements and carbohydrate amounts untilthe hypoglycemia is remedied.

To compute a third amount of carbohydrate (n_(BU,3)), the current, thirdblood glucose reading (BG₃) is considered along with the previousmeasurements (BG₁ and BG₂). Specifically, at the third measurement time(t₃), the third very low (BG_(vl,3)), third low (BG_(l,3)), and thirdmedium-low (BG_(ml,3)) blood glucose limits depend upon the first (BG₁)and second (BG₂) blood glucose measurements as well as the time elapsed.The third very low (BG_(vl,3)), third low (BG_(l,3)), and thirdmedium-low (BG_(ml,3)) blood glucose limits are generally obtained bysuperimposing the effect of the first (n_(BU,1)) and second (n_(BU,2))carbohydrate amounts on patient blood glucose concentration. Equation 19below shows an example of how these third limits are calculated (seealso, equation 10).

$\begin{matrix}\left\{ \begin{matrix}{{BG}_{{vl},3} = {{{\gamma \left( {t - t_{2}} \right)} \cdot {BG}_{{vl},3}} + {\left( {1 - {\gamma \left( {t - t_{2}} \right)}} \right) \cdot {BG}_{2}} + {\frac{\gamma \left( {t - t_{2}} \right)}{\gamma \left( {t_{2} - t_{1}} \right)}\left( {{\gamma \left( {t - t_{1}} \right)} - 1} \right)\left( {{BG}_{2} - {BG}_{1}} \right)}}} \\{{BG}_{l,3} = {{{\gamma \left( {t - t_{2}} \right)} \cdot {BG}_{l,3}} + {\left( {1 - {\gamma \left( {t - t_{2}} \right)}} \right) \cdot {BG}_{2}} + {\frac{\gamma \left( {t - t_{2}} \right)}{\gamma \left( {t_{2} - t_{1}} \right)}\left( {{\gamma \left( {t - t_{1}} \right)} - 1} \right)\left( {{BG}_{2} - {BG}_{1}} \right)}}} \\{{BG}_{{ml},3} = {{{\gamma \left( {t - t_{2}} \right)} \cdot {BG}_{{ml},3}} + {\left( {1 - {\gamma \left( {t - t_{2}} \right)}} \right) \cdot {BG}_{2}} + {\frac{\gamma \left( {t - t_{2}} \right)}{\gamma \left( {t_{2} - t_{1}} \right)}\left( {{\gamma \left( {t - t_{1}} \right)} - 1} \right)\left( {{BG}_{2} - {BG}_{1}} \right)}}}\end{matrix} \right. & {{Equation}\mspace{14mu} 19}\end{matrix}$

-   -   where:        -   BG_(vl,3)=Very low blood glucose range limit or threshold            for a third amount of carbohydrate (i.e., at time t₃);        -   BG_(l,3)=Low blood glucose range limit or threshold for a            third amount of carbohydrate (i.e., at time t₃);        -   BG_(ml,3)=Medium-low blood glucose range limit or threshold            for a third amount of carbohydrate (i.e., at time t₃);        -   γ(x)=Carbohydrate absorption function for time interval x;        -   t=Current time when relative threshold is being calculated;        -   t_(n)=Time of n^(th) measurement since hypoglycemia; and        -   BG_(n)=n^(th) blood glucose measurement since hypoglycemia.

Based on the limits calculated in equation 19 above, the third amount ofcarbohydrate (n_(BU,3)) to ingest can be calculated through equation 20.

$\begin{matrix}{n_{{BU},3} = \left\{ \begin{matrix}0 & {{{if}\mspace{14mu} {BG}_{{ml},3}} < {BG}_{3}} \\n_{{BU},{small}} & {{{if}\mspace{14mu} {BG}_{l,3}} < {BG}_{3} \leq {BG}_{{ml},3}} \\n_{{BU},{medium}} & {{{if}\mspace{14mu} {BG}_{{vl},3}} < {BG}_{3} \leq {BG}_{l,3}} \\n_{{BU},{large}} & {{{if}\mspace{14mu} {BG}_{3}} \leq {BG}_{{vl},3}}\end{matrix} \right.} & {{Equation}\mspace{14mu} 20}\end{matrix}$

-   -   where:        -   n_(BU,3)=Third amount of carbohydrate to ingest (i.e., at            time t₃);        -   n_(BU,small)=Small amount of carbohydrate;        -   n_(BU,medium)=Medium amount of carbohydrate;        -   n_(BU,large)=Large amount of carbohydrate;        -   BG₃=Third blood glucose measurement (i.e., at time t₃);

Again, it should be appreciated that the meter 104 determines the small(n_(BU,small)), medium (n_(BU,medium)), and large (n_(BU,large))carbohydrate amounts based on the equations 11-15 as was discussedabove. Of course, the physician or other health care provider can adjustthese recommended carbohydrate amounts so as to customize the amountsfor the particular needs of the patient.

FIGS. 13, 14, 15, and 16 illustrate how the third carbohydrate amountsare determined with different absorption models having different initialconditions. In these graphs, the third of amount carbohydrate (n_(BU,3))depends on the first (BG₁), second (BG₂), and third second (BG₃) bloodglucose measurements respectively obtained at the first measurement time(t₁) when hypoglycemia was detected, the second measurement time (t₂),and the third measurement time (t₃). It should be noted that in thesegraphs the time scale starts at the second measurement time (t₂), whichin this example is 15 minutes after hypoglycemia detection.

In FIGS. 13 and 14, the first blood glucose measurement (BG₁) was 90mg/dl, and the second blood glucose measurement (BG₂) was 40 mg/dl. Thethird very low (BG_(vl,3)), low (BG_(l,3)), and medium-low (BG_(ml,3))blood glucose limits in both graphs are plotted as a function of time(t=t₃−t₁) with the first very low (BG_(vl,1)), low (BG_(l,1)), andmedium-low (BG_(ml,1)) blood glucose limits respectively equal 60, 100,and 140 mg/dl. The carbohydrate absorption function (γ(x)) for the thirdcarbohydrate amount in FIG. 13 is based on linear absorption model C aswas formulated in equation 6 above and illustrated in FIG. 6. Incontrast, the carbohydrate absorption function (γ(x)) for the thirdcarbohydrate amount in FIG. 14 is based on parabolic absorption model Bas was formulated in equation 5 above and illustrated in FIG. 6. As canbe seen, the third very low (BG_(vl,3)), low (BG_(l,3)), and medium-low(BG_(ml,3)) blood glucose limits in FIGS. 13 and 14 are initially equalto 40 mg/dl and increase much faster toward the limits as compared tothose shown in FIGS. 9 and 10. This is due to the negative differencebetween the first (BG₂) and second (BG₁) blood glucose measurementswhich in turn shows that the first carbohydrate amount (n_(BU,1)) wastoo small to bring the blood glucose level back into the control range.As a result, a more aggressive pattern for addressing the hypoglycemiais proposed in order to compute larger amounts of carbohydrates.

In FIGS. 15 and 16, the first blood glucose measurement (BG₁) was 40mg/dl, and the second blood glucose measurement (BG₂) was 90 mg/dl. Thethird very low (BG_(vl,3)), low (BG_(l,3)), and medium-low (BG_(ml,3))blood glucose limits in both graphs are plotted as a function of time(t=t3−t₁) with the first very low (BG_(vl,1)), low (BG_(l,1)), andmedium-low (BG_(ml,1)) blood glucose limits respectively equal 60, 100,and 140 mg/dl. The carbohydrate absorption function (γ(x)) for the thirdcarbohydrate amount in FIG. 15 is based on linear absorption model C,and the carbohydrate absorption function (γ(x)) for the thirdcarbohydrate amount in FIG. 16 is based on parabolic absorption model B.As can be seen, the third very low (BG_(vl,3)), low (BG_(l,3)), andmedium-low (BG_(ml,3)) blood glucose limits in both FIGS. 15 and 16 areinitially equal to 90 mg/dl at the second measurement time (t₂), andthey tend to initially decrease before approaching the 60, 100, and 140mg/dl limit values. This is due to the large positive difference betweenthe first (BG₂) and second (BG₁) blood glucose measurements which inturn shows that the first carbohydrate amount (n_(BU,1)) was effectivein bringing the blood glucose level back into the control range. As aresult, a less aggressive approach for addressing the hypoglycemia isproposed in this situation in which smaller amounts of carbohydrates arerecommended.

As noted before, this method can be used to calculate carbohydrateamounts (n_(BU)) even after three recommendations for ingestingcarbohydrates. If three or more ingestions of carbohydrates occur afterdetecting hypoglycemia, the very low (BG_(vl)), low (BG₁), andmedium-low (BG_(ml)) blood glucose limits or thresholds are obtained bysuperimposing the effects of the previous carbohydrate amounts. In thissituation, the carbohydrate amount (n_(BU)) can be genericallycharacterized by equation 21 below.

$\begin{matrix}{n_{BU} = \left\{ \begin{matrix}0 & {{{if}\mspace{14mu} {BG}_{ml}} < {BG}} \\n_{{BU},{small}} & {{{if}\mspace{14mu} {BG}_{l}} < {BG} \leq {BG}_{ml}} \\n_{{BU},{medium}} & {{{if}\mspace{14mu} {BG}_{vl}} < {BG} \leq {BG}_{l}} \\n_{{BU},{large}} & {{{if}\mspace{14mu} {BG}} \leq {BG}_{vl}}\end{matrix} \right.} & {{Equation}\mspace{14mu} 21}\end{matrix}$

In a further variation, to simplify the calculation of the very low(BG_(vl)), low (BG₁), and medium-low (BG_(ml)) blood glucose limits,only three or even two of the last blood glucose measurements, includingthe current blood glucose measurement, are used. In this situation, allprevious measurements would be considered, but the carbohydrateingestion would be ignored.

FIG. 17 is a flowchart 1700 that illustrates another method fordetecting and treating hypoglycemia. In this method, the differencebetween the current blood glucose measurement and a target blood glucoselevel are calculated in order to determine the recommended amount ofcarbohydrates to ingest for the patient so as to treat the hypoglycemia.As can be seen, the flowchart 1700 in FIG. 17 shares a number of stagesin common with the flowchart 700 in FIG. 7. For the sake of clarity andbrevity, these stages sharing a common reference number will not bediscussed in detail below, but reference is made to the previousdiscussion of these stages in FIG. 7. Looking at FIG. 17, instead ofcategorizing the amounts of carbohydrates as being small, medium, large,the meter 104 in stage 1702 simply calculates the initial or firstcarbohydrate amount (n_(BU,1)) based on the difference between the firstblood glucose measurement (BG₁) and the desired target blood glucoselevel (see e.g., equation 11). In stage 1704, meter 104 compares theblood measurement to a low, relative target (BG_(end,relative)) so as todetermine whether the surveillance phase 506 can end (see, equations 2,9, and 10). The meter 104 in stage 1706 compares the current bloodglucose level to a hypoglycemia surveillance end threshold(BG_(hypoend)) to determine whether the surveillance phase can end (see,equation 1). Like in stage 1702, the meter 104 in stage 1708 simplycalculates the subsequent carbohydrate amounts (n_(BU)) based on thedifference between the current blood glucose measurement and a desiredtarget blood glucose level.

For the sake of clarity as well as brevity, the methods were describedabove as being performed by the meter 104, but it should be appreciatedthat these methods can be performed, whole or in part, using otherdevices, such as the computer 102, insulin pump 106, cellular phones,etc. It should be appreciated that the meter 104 (or other devices)performs the acts in these methods through the processor 202, memory204, I/O device 206, and/or other components. While these methods weredescribed with respect to a patient, this term was used in the broadsense, and it should be appreciated that these methods can used by otherindividuals who may not be considered a patient of a particular healthcare provider and can be even adapted for use with human and animalsubjects.

Moreover, it is contemplated that the various stages and phasesdescribed herein and illustrated in the drawings can occur in differentorders than is shown. Furthermore, one or more of these acts can becombined together and other acts not described herein can be performedalongside with these methods. In other variations, instead of thepatient entering in whether they feel hypoglycemic, the meter 104 orother device can actively monitor the patient so as to automaticallyenter the information. For example, the meter 104 can make the patientperform a test as well as check their visual and mental acuity alongwith other symptoms or hypoglycemia through video or speech recognitionsoftware. Questions in a questionnaire from the meter 104 about thesymptoms can be simple yes/no questions or can be more specificallydetailed such as via a drop down list. In another example, the meter 104via a microphone can monitor the speech of the patient to see if thepatient is experiencing a speech impediment indicative of hypoglycemia,such as slurred speech. The meter 104 can visually monitor the patientfor symptoms of hypoglycemia via a video camera to see if anythingvisually indicates that the patient is experiencing hypoglycemia, suchas excessive sweating and/or motor control problems. When the bloodglucose meter 104 is used to collect data for these methods, then bloodglucose value can either be processed directly if the meter hosts thehypoglycemia detection algorithm or the value is transmitted to the pump106 or the computer 102 hosting the hypoglycemia detection algorithm.The methods described above used a 15 minute delay between glucosemeasurements, but it should be recognized that the delay can be more orless than 15 minutes in other embodiments.

The glucose meter 104 as described above can include discrete orcontinuous type glucose monitors. Moreover, the glucose meter 104 canfor example measure glucose levels using electrochemical and/orphotometric analysis techniques. It should be appreciated that bloodglucose levels can be measured through invasive or non-invasiveprocedures, and various types of body fluids, like blood or interstitialfluid, can be analyzed. In one embodiment the glucose meter 104 is anACCU-CHEK® Aviva brand glucose meter, but it should be appreciated thatother types of glucose meters can be used. It should be appreciated thatthe blood glucose meter 104 can be configured in any number of manners.For example, the meter 104 and the insulin pump 106 can be combinedtogether to form a single unit or various components of these systemscan be spread across multiple units. The meter 104 can includeadditional ports to connect additional biosensors to measure a pluralityof features such as body temperature, pulse, and/or blood oxygencontent. It should be appreciated that commercial forms of the meter 104can include other components and/or perform other functions than thosedescribed herein.

While the insulin pump 106 is illustrated in FIG. 1, insulin or othermedication can be delivered in other manners, such as with syringes.Moreover, the above-described methods can be performed with other typesof systems besides those illustrated in the drawings and/or with othercombinations of devices. For example, the hypoglycemia detection andhandling method can run on the insulin pump 106 directly or on the bloodglucose meter 104. Note that any device allowing diabetes managementsuch as a smart phone or a pocket PC could host a similar application.

The insulin pump 106 can be connected to the blood glucose meter 104and/or the computer 102. The connection may be used to transmit datafrom the blood glucose meter 104 and/or the computer 102 to the insulinpump 106 or vice versa. For example, the electronic connection may alsobe used to transmit instructions from the glucose meter 104 to theinsulin pump 106 regarding one or more injections of insulin from thepump into the patient. Additionally, the connection may transmitinformation regarding past, present, or future injections or insulinlevels from the insulin pump 106 to the glucose meter 104 and/or thecomputer 102. Similar to the electronic connection discussed above, theconnection between the glucose meter 104 and/or the insulin pump 106 maybe wired or wireless and may be the same or a different type ofconnection than the one between the meter 104, insulin pump 106, and/orthe computer 102.

While various embodiments of systems and methods for detecting andhandling hypoglycemia have been described in considerable detail herein,the embodiments are merely offered by way of non-limiting examples ofthe disclosure described herein. It will therefore be understood thatvarious changes and modifications may be made, and equivalents may besubstituted for elements thereof, without departing from the scope ofthe disclosure. Indeed, this disclosure is not intended to be exhaustiveor to limit the scope of the disclosure.

Further, in describing representative embodiments, the disclosure mayhave presented a method and/or process as a particular sequence ofsteps. However, to the extent that the method or process does not relyon the particular order of steps set forth herein, the method or processshould not be limited to the particular sequence of steps described.Other sequences of steps may be possible. Therefore, the particularorder of the steps disclosed herein should not be construed aslimitations of the present disclosure. In addition, disclosure directedto a method and/or process should not be limited to the performance oftheir steps in the order written. Such sequences may be varied and stillremain within the scope of the present disclosure.

Having described the present disclosure in detail and by reference tospecific embodiments thereof, it will be apparent that modifications andvariations are possible without departing from the scope of thedisclosure defined in the appended claims. More specifically, althoughsome aspects of the present disclosure are identified herein aspreferred or particularly advantageous, it is contemplated that thepresent disclosure is not necessarily limited to these preferred aspectsof the disclosure.

1. A computerized method of detecting and treating hypoglycemia,comprising: detecting hypoglycemia in a patient with a computing devicebased at least on the patient having a symptom of hypoglycemia;receiving with the computing device a blood glucose measurement of thepatient; computing a recommended carbohydrate amount to ingest by thepatient with the computing device in response to said detecting thehypoglycemia, wherein the recommended carbohydrate amount is based atleast in part on the blood glucose measurement of the patient;outputting the recommended carbohydrate amount with the computing deviceto provide the patient with a visual representation of a recommendationto treat hypoglycemia and return a blood glucose level of the patientback to a non-hypoglycemic level in a manner that assists with reducingthe length of or eliminating hypoglycemia and ensures resolution ofhypoglycemic events. and performing hypoglycemia surveillance with thecomputing device to determine whether the recommended carbohydrateamount remedied the hypoglycemia.
 2. The method according to claim 1,wherein said computing the recommended carbohydrate amount includesadjusting the recommended carbohydrate amount based on amount ofcarbohydrates consumed by the patient during a timeframe.
 3. Acomputerized method of detecting and treating hypoglycemia, comprising:receiving with a computing device a blood glucose measurement of apatient; computing a recommended carbohydrate amount to ingest by thepatient with the computing device, wherein the recommended carbohydrateamount is based at least on the blood glucose measurement of thepatient, wherein said computing the recommended carbohydrate amountincludes adjusting the recommended carbohydrate amount based on anamount of carbohydrates consumed by the patient during a timeframe;outputting the recommended carbohydrate amount with the computing deviceto provide the patient with a visual representation of a recommendationto treat hypoglycemia and return a blood glucose level of the patientback to a non-hypoglycemic level; and performing hypoglycemiasurveillance with a the computing device after a delay period todetermine whether the recommended carbohydrate amount remedied thehypoglycemia, wherein the recommendation and the surveillance after thedelay period assists with reducing the length of or eliminatinghypoglycemia and ensures resolution of hypoglycemic events. 4.(canceled)
 5. A method, comprising: detecting hypoglycemia in a patientwith a computing device; computing a recommended carbohydrate amount toingest by the patient with the computing device in response to saiddetecting the hypoglycemia; outputting the recommended carbohydrateamount with the computing device; and performing hypoglycemiasurveillance with the computing device to determine whether therecommended carbohydrate amount remedied the hypoglycemia.
 6. The methodaccording to claim 5, wherein the hypoglycemia surveillance includes:receiving with the computing device a second blood glucose measurementof the patient after said computing the recommended carbohydrate amount;and determining with the computing device that the hypoglycemia has beenremedied based at least on the second blood glucose measurement.
 7. Themethod according to claim 5, further comprising: receiving with thecomputing device data indicating that the patient lacks hypoglycemiasymptoms after said computing the recommended carbohydrate amount; anddetermining with the computing device that the hypoglycemia has beenremedied based at least on the lack of the hypoglycemia symptoms.
 8. Themethod according to claim 5, further comprising: delaying saidperforming the hypoglycemia surveillance for a delay period.
 9. Themethod according to claim 8, wherein the delay period is at least 15minutes.
 10. The method according to claim 6, further comprising: endingsaid performing the hypoglycemia surveillance when the second bloodglucose measurement exceeds a surveillance end threshold.
 11. The methodaccording to claim 10, wherein the surveillance end threshold is 100mg/dl.
 12. The method according to claim 6, further comprising: endingsaid performing the hypoglycemia surveillance when the second bloodglucose measurement exceeds a relative threshold that varies based onamount of carbohydrates previously consumed.
 13. The method according toclaim 12, wherein the relative threshold is based on a time dependentcarbohydrate absorption function that increases with time.
 14. Themethod according to claim 12, further comprising: calculating with thecomputing device the relative threshold using the following formulaBG_(end,relative)=γ(t−t ₁)·BG_(hypo,end)+(1−γ(t−t ₁))·BG₀ where:BG_(end,relative)=Relative threshold for ending the surveillance phase;BG_(hypo,end)=Threshold where hypoglycemia is considered ended;γ(x)=Carbohydrate absorption function for time interval x; t=Currenttime when relative threshold is being calculated; t₁=Time when firstcarbohydrate recommended or consumed; and BG₀=Original blood glucosemeasurement.
 15. The method according to claim 12, further comprising:receiving a third blood glucose measurement; calculating with thecomputing device the relative threshold using the following formula${BG}_{{end},{relative}} = {{{\gamma \left( {t - t_{2}} \right)} \cdot {BG}_{{hypo},{end}}} + {\left( {1 - {\gamma \left( {t - t_{2}} \right)}} \right) \cdot {BG}_{2}} + {\frac{\gamma \left( {t - t_{2}} \right)}{\gamma \left( {t_{2} - t_{1}} \right)}\left( {{\gamma \left( {t - t_{1}} \right)} - 1} \right)\left( {{BG}_{2} - {BG}_{1}} \right)}}$where: BG_(end,relative)=Relative threshold for ending the surveillancephase; BG_(hypo,end)=Threshold where hypoglycemia is considered ended;γ(x)=Carbohydrate absorption function for time interval x; t=Currenttime when relative threshold is being calculated; t_(n)=Time of n^(th)measurement since hypoglycemia; and BG_(n)=n^(th) blood glucosemeasurement since hypoglycemia.
 16. The method according to claim 5,wherein the recommended carbohydrate amount is selected from a groupconsisting of a small carbohydrate amount, a medium carbohydrate amount,and a large carbohydrate amount.
 17. The method according to claim 5,further comprising: normalizing the recommended carbohydrate amountbased on patient weight.
 18. The method according to claim 5, furthercomprising: adjusting the recommended carbohydrate amount based onpatient weight risk of fainting during hypoglycemia.
 19. The methodaccording to claim 5, further comprising: adjusting the recommendedcarbohydrate amount based on a total daily dose of insulin by thepatient.
 20. The method according to claim 5, further comprising:calculating with the computing device the recommended carbohydrateamount using the following formula $\quad\left\{ \begin{matrix}{n_{{BU},{small}} = {f_{n}\left( {n_{{BU},{TDD}} + n_{{BU},{fainting}}} \right)}} \\{n_{{BU},{medium}} = {f_{n}\left( {n_{{BU},{TDD}} + n_{{BU},{fainting}} + 1} \right)}} \\{n_{{BU},{large}} = {f_{n}\left( {n_{{BU},{TDD}} + n_{{BU},{fainting}} + 2} \right)}}\end{matrix} \right.$ where: n_(BU,small)=Small amount of carbohydrate;n_(BU,methum)=Medium amount of carbohydrate; n_(BU,large)=Large amountof carbohydrate; f_(n)=Normalization factor based on patient weight;n_(BU,fainting)=Risk of fainting additional bread unit; andn_(BU,TDD)=Additional bread unit recommended for patients with a totaldaily dose (TDD) of insulin ≤30 UI.
 21. The method according to claim16, wherein said computing the recommended carbohydrate amount includesselecting the small carbohydrate amount, the medium carbohydrate amount,and the large carbohydrate amount based on a very low blood glucoselimit, a low blood glucose limit, and a medium-low blood glucose limit.22. The method according to claim 21, wherein the very low blood glucoselimit, the low blood glucose limit, and the medium-low blood glucoselimit are respectively 60 mg/dl, 100 mg/dl, and 140 mg/dl.
 23. Themethod according to claim 21, further comprising: calculating with thecomputing device the recommended carbohydrate amount using the followingformula $\begin{matrix}{n_{BU} = \left\{ \begin{matrix}0 & {{{if}\mspace{14mu} {BG}_{ml}} < {BG}} \\n_{{BU},{small}} & {{{if}\mspace{14mu} {BG}_{l}} < {BG} \leq {BG}_{ml}} \\n_{{BU},{medium}} & {{{if}\mspace{14mu} {BG}_{vl}} < {BG} \leq {BG}_{l}} \\n_{{BU},{large}} & {{{if}\mspace{14mu} {BG}} \leq {BG}_{vl}}\end{matrix} \right.} & {{Equation}\mspace{14mu} 21}\end{matrix}$ where: n_(BU)=Amount of carbohydrate; n_(BU,small)=Smallamount of carbohydrate; n_(BU,medium)=Medium amount of carbohydrate;n_(BU,large)=Large amount of carbohydrate; BG₁=Blood glucose measurementat hypoglycemia detection; BG_(ml)=Medium-low blood glucose range limit;BG₁=Low blood glucose range limit; and BG_(vl)=Very low blood glucoserange limit.
 24. The method according to claim 5, wherein said computingthe recommended carbohydrate amount includes adjusting the recommendedcarbohydrate amount based on prior blood glucose measurements made afterdetecting the hypoglycemia, prior amounts of carbohydrates ingested, anda carbohydrate absorption function.
 25. The method according to claim 5,further comprising: receiving a second blood glucose measurement afterthe patient ingested the second recommended amount of carbohydrate;calculating with the computing device a second recommended carbohydrateamount using the following formula $\quad\left\{ \begin{matrix}{{BG}_{{vl},2} = {{{\gamma \left( {t - t_{1}} \right)} \cdot {BG}_{{vl},1}} + {\left( {1 - {\gamma \left( {t - t_{1}} \right)}} \right) \cdot {BG}_{1}}}} \\{{BG}_{l,2} = {{{\gamma \left( {t - t_{1}} \right)} \cdot {BG}_{l,1}} + {\left( {1 - {\gamma \left( {t - t_{1}} \right)}} \right) \cdot {BG}_{1}}}} \\{{BG}_{{ml},2} = {{{\gamma \left( {t - t_{1}} \right)} \cdot {BG}_{{ml},1}} + {\left( {1 - {\gamma \left( {t - t_{1}} \right)}} \right) \cdot {BG}_{1}}}}\end{matrix} \right.$ where: BG_(vl,2)=Very low blood glucose rangelimit or threshold for a second amount of carbohydrate; BG_(l,2)=Lowblood glucose range limit or threshold for a second amount ofcarbohydrate; BG_(ml,2)=Medium-low blood glucose range limit orthreshold for a second amount of carbohydrate; γ(x)=Carbohydrateabsorption function for time interval x; t=Current time when relativethreshold is being calculated; t₁=Time when first carbohydrate wasconsumed; and BG₁=First blood glucose measurement.
 26. The methodaccording to claim 25, further comprising: receiving a third bloodglucose measurement after the patient ingested the second recommendedamount of carbohydrate; calculating with the computing device a thirdrecommended carbohydrate amount using the following formula$\quad\begin{matrix}\left\{ \begin{matrix}{{BG}_{{vl},3} = {{{\gamma \left( {t - t_{2}} \right)} \cdot {BG}_{{vl},3}} + {\left( {1 - {\gamma \left( {t - t_{2}} \right)}} \right) \cdot {BG}_{2}} + {\frac{\gamma \left( {t - t_{2}} \right)}{\gamma \left( {t_{2} - t_{1}} \right)}\left( {{\gamma \left( {t - t_{1}} \right)} - 1} \right)\left( {{BG}_{2} - {BG}_{1}} \right)}}} \\{{BG}_{l,3} = {{{\gamma \left( {t - t_{2}} \right)} \cdot {BG}_{l,3}} + {\left( {1 - {\gamma \left( {t - t_{2}} \right)}} \right) \cdot {BG}_{2}} + {\frac{\gamma \left( {t - t_{2}} \right)}{\gamma \left( {t_{2} - t_{1}} \right)}\left( {{\gamma \left( {t - t_{1}} \right)} - 1} \right)\left( {{BG}_{2} - {BG}_{1}} \right)}}} \\{{BG}_{{ml},3} = {{{\gamma \left( {t - t_{2}} \right)} \cdot {BG}_{{ml},3}} + {\left( {1 - {\gamma \left( {t - t_{2}} \right)}} \right) \cdot {BG}_{2}} + {\frac{\gamma \left( {t - t_{2}} \right)}{\gamma \left( {t_{2} - t_{1}} \right)}\left( {{\gamma \left( {t - t_{1}} \right)} - 1} \right)\left( {{BG}_{2} - {BG}_{1}} \right)}}}\end{matrix} \right. & \;\end{matrix}$ where: BG_(vl,3)=Very low blood glucose range limit orthreshold for a third amount of carbohydrate (i.e., at time t₃);BG_(l,3)=Low blood glucose range limit or threshold for a third amountof carbohydrate (i.e., at time t₃); BG_(ml,3)=Medium-low blood glucoserange limit or threshold for a third amount of carbohydrate (i.e., attime t₃); γ(x)=Carbohydrate absorption function for time interval x;t=Current time when relative threshold is being calculated; t_(n)=Timeof n^(th) measurement since hypoglycemia; and BG_(n)=n^(th) bloodglucose measurement since hypoglycemia.
 27. The method according toclaim 5, further comprising: calculating subsequent amounts ofcarbohydrates by superimposing the effects of previous carbohydrateamounts.
 28. The method according to claim 21, further comprising:calculating the very low blood glucose limit, the low blood glucoselimit, and the medium-low blood glucose limit based on no more than thelast three blood glucose measurements.
 29. The method according to claim13, further comprising: calculating with the computing device thecarbohydrate absorption function using the following formula$\quad\left\{ \begin{matrix}{{\gamma (x)} = 0} & {{{if}\mspace{14mu} x} = 0} \\{{\gamma (x)} = {{{- 0.000125} \cdot x^{2}} + {0.022525 \cdot x} + 0.0019}} & {{{if}\mspace{14mu} 0} < x < 78} \\{{\gamma (x)} = 1} & {{{if}\mspace{14mu} x} \geq 78}\end{matrix} \right.$ where: γ(x)=Carbohydrate absorption function; andx=Time frame of interest (in minutes).
 30. The method according to claim13, further comprising: calculating with the computing device thecarbohydrate absorption function using the following formula$\quad\left\{ \begin{matrix}{{\gamma (x)} = {{{- \frac{1}{t_{a}^{2}}}x^{2}} + {\frac{2}{t_{a}}x}}} & {{{if}\mspace{14mu} 0} \leq x \leq t_{a}} \\{{\gamma (x)} = 1} & {{{if}\mspace{14mu} x} > t_{a}}\end{matrix} \right.$ where: γ(x)=Carbohydrate absorption function;x=Time frame of interest (in minutes); and t_(a)=Total carbohydrateabsorption time.
 31. The method according to claim 13, furthercomprising: calculating with the computing device the carbohydrateabsorption function using the following formula$\quad\left\{ \begin{matrix}{{\gamma (x)} = {\frac{1}{t_{a}}x}} & {{{if}\mspace{14mu} 0} \leq x \leq t_{a}} \\{{\gamma (x)} = 1} & {{{if}\mspace{14mu} x} > t_{a}}\end{matrix} \right.$ where: γ(x)=Carbohydrate absorption function;x=Time frame of interest (in minutes); and t_(a)=Total carbohydrateabsorption time.
 32. The method according to claim 13, furthercomprising: calculating with the computing device the carbohydrateabsorption function using the following formulaγ(x)=1−e ^(−a·x) where: γ(x)=Carbohydrate absorption function; x=Timeframe of interest (in minutes); and a=0.03.
 33. The method according toclaim 13, further comprising: calculating with the computing device thecarbohydrate absorption function using the following formulaγ(x)=1−e ^(−a·x) ^(−bx) where: γ(x)=Carbohydrate absorption function;x=Time frame of interest (in minutes); a=0.0004; and b=0.015.
 34. Themethod according to claim 13, wherein the carbohydrate absorptionfunction is a linear function.
 35. The method according to claim 13,wherein the carbohydrate absorption function is a parabolic function.36. The method according to claim 13, wherein the carbohydrateabsorption function is an exponential function.
 37. The method accordingto claim 5, further comprising: receiving with the computing device amanual input that the patient has the symptom of hypoglycemia.
 38. Themethod according to claim 5, further comprising: determiningautomatically with the computing device that the patient has the symptomof hypoglycemia.
 39. The method according to claim 38, wherein saiddetermining automatically includes analyzing results from aquestionnaire to detect hypoglycemic symptoms with the computing device.40. The method according to claim 38, wherein said determiningautomatically includes analyzing a video of the patient for thehypoglycemic symptoms with the computing device.
 41. The methodaccording to claim 38, wherein said determining automatically includesanalyzing speech of the patient for the hypoglycemic symptoms with thecomputing device.